Association of athlete's foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples.

We performed a study to determine how often patients with cellulitis of the lower extremities in the absence of trauma, peripheral vascular disease, or chronic open ulcers have ipsilateral interdigital athlete's foot and whether cultures of samples from the involved interdigital spaces would yield potentially pathogenic bacteria. Athlete's foot was present in 20 (83%) of 24 episodes of cellulitis that were studied. Cultures of samples from interdigital spaces yielded Beta-hemolytic streptococci in 17 (85%) of 20 cases, Staphylococcus aureus in 9 (45%) of 20 cases, and gram-negative rods in 7 (35%) of 20 cases. Only Beta-hemolytic streptococci were recovered significantly more often from patients than from a group of controls with athlete's foot who did not have cellulitis (P < .01). Athlete's foot may be a common predisposing condition for cellulitis of the lower extremities. In comparison with attempts at microbiological diagnosis such as aspiration and/or biopsy of the area of cellulitis, cultures of samples from the interdigital spaces combined with serial determinations of antistreptolysin titers may offer a simpler noninvasive method of microbiological diagnosis.

Transient bullous dermolysis of the newborn. Case report and review of pathogenesis.

A case of transient bullous dermolysis of the newborn is reported. A healthy Hispanic newborn developed bullae during the first two days of life. From age two to four weeks, the lesions healed with milia formation. There was no residual scarring or hypopigmentation. An induced blister showed dermal-epidermal separation with the PAS-positive basement membrane in the epidermal roof. PAS-positive inclusions were present in the cytoplasm of a few basal cells. Examination by electron microscopy showed degeneration of the collagen and anchoring fibrils. There were numerous stellate inclusions in the endoplasmic reticulum of the cytoplasm of the lesional basal keratinocytes.

The effect of cyclosporine on macrophage oxidative burst potential during graft-versus-host reactions in mice.

The development of graft-versus-host reactions in mice was characterized by an increase in activated macrophage populations in the peritoneum and spleen of the animals. In the present study we tested the effect of the immunosuppressive agent CsA on the appearance and activity of such macrophages. Parental spleen lymphocytes were injected intraperitoneally into F1 hybrids (BALB/c x C57Bl/6), and 13 days following injection we monitored the number of peritoneal exudate cells (PEC), spleen enlargement, and the oxidative burst (OB) of adherent peritoneal macrophages (APM). Macrophage OB was assessed by measuring O2- and H2O2 production, following stimulation with 12-O-tetradecanoyl-phorbol-13-acetate (TPA). In GVHR mice a 72% increase in their spleen to body weight ratio was observed, whereas in CsA-treated GVHR mice only a 32% increase was evident. Assessment of the effect of CsA on the number and function of peritoneal cells revealed that CsA caused a 73% reduction in the number of infiltrating PEC in GVHR mice. Furthermore, measurements of H2O2 and O2- production by APM revealed that the overall OB capacity of APM from CsA-treated mice was significantly reduced compared to APM from nontreated GVHR mice. CsA had no effect on the number and OB activity of paraffin oil elicited or resident PEC. These results indicate that CsA may prevent recall and activation of macrophages via its effect on T cell lymphokine release and thus may lessen the contribution of macrophage-derived toxic reagents to the damage inflicted by GVHR.

Multifocal adenocarcinoma of the proximal small intestine in a patient with celiac sprue.

Adenocarcinoma of the small intestine is a known complication of celiac sprue. We report a 63-year-old man with a history of celiac disease who developed anemia, guaiac-positive stools, and jaundice. Five discrete adenocarcinomas of the proximal small intestine were identified over a 9 year period. Endoscopic retrograde cholangiopancreatographic (ERCP) and radiographic evaluation of the small bowel were helpful in diagnosing adenocarcinoma involving the ampulla of Vater and jejunum. This case demonstrates for the first time the multifocal, malignant potential of sprue. It also illustrates the importance of an aggressive, systematic work-up of patients whose course has changed despite dietary restriction.

Acanthosis nigricans associated with mycosis fungoides.

A case of acanthosis nigricans coexistent with mycosis fungoides, the second report in the literature of such an association, is described.

Pemphigus foliaceus-like, immunologically negative dermatosis in a patient with T cell chronic lymphocytic leukemia.

A 56-year-old black man developed a pemphigus foliaceus-like bullous eruption as the initial presentation of chronic T cell lymphocytic leukemia. Histologic examination disclosed superficial acantholysis consistent with pemphigus foliaceus and an infiltrate of atypical lymphoid cells in the papillary dermis. Repeated direct and indirect immunofluorescence studies yielded negative results. Acantholysis could be reproduced in vitro by incubation of normal human skin with the patient's serum and plasma but not with blister fluid. In the following months, the course of the bullous eruption paralleled that of the leukemia.

Surgical management of craniosynostosis.

With an incidence of approximately 1 in 2,000 per head of population, most neurosurgeons are presented at times with the problem of craniosynostosis. This paper summarises the different clinical effects of different skull deformities, and describes the present state of the art with regard to surgical management.

Scleromyxedema with corneal deposits.

Scleromyxedema (Arndt-Gottron syndrome) is a rare cutaneous disease in which hyaluronic acid is deposited in the dermis. The authors describe a patient with scleromyxedema and corneal deposits. A corneal biopsy demonstrated hyaluronic acid deposition in the corneal stroma and amyloid P component in Bowman's membrane. This is the first report of scleromyxedema involving the cornea. It is also the first report of amyloid P component deposition in the cornea occurring independent of corneal amyloid deposits.

Increased oxidative burst potential exhibited by macrophages during graft-versus-host reactions in mice.

Graft versus host reactions (GVHR) in mice are accompanied by macrophage activation. Since macrophage oxidative burst (OB) was found to increase in activated macrophages (MPs), we examined the OB of peritoneal and spleen MPs from mice during GVHR. Parental spleen lymphocytes, were injected i.p. into F1 hybrids (BALB/cXC57Bl/6) and at different intervals following injection we monitored the number of peritoneal exudate cells (PEC), spleen enlargement, and the OB of both peritoneal and spleen adherent MPs. Macrophage OB was assessed by measuring O-2 and H2O2 production, following stimulation with the phorbol ester TPA. The spleen-to-body weight ratio increased by 40-70% in mice with GVHR during the period of 6-20 days post-injection and decreased to almost normal levels after 27 days. In such mice with GVHR the number of PEC returned to normal (approximately equal to 6 X 10(6) cells/animal) after 20 days compared with 5 days in control mice (injected with F1 spleen cells). Adherent peritoneal MPs from control mice and mice with GVHR exhibited increased OB activity 3 days following treatment. However, in the control mice the OB response returned to normal within 6 days, while in the experimental mice it showed a slight decrease after 6 days, increased again within 9-17 days, and finally decreased 20-27 days after treatment. Adherent spleen MPs from mice with GVHR generated a high response 6 days posttreatment, which gradually returned to the basal level after 17 days. These findings suggest that during GVHR in mice, macrophage OB was potentiated, giving rise to cytotoxic products such as O2- and H2O2, which may contribute to tissue damage during GVHR.

Craniofacial surgery.

Craniofacial surgery is concerned with the treatment of congenital and acquired conditions affecting the head, face and jaws (Tessier, 1971a). Previously these were treated individually by plastic, neurological and faciomaxillary surgeons. This type of surgery was associated with a high risk of morbidity and mortality (Goldin, 1975). Following the pioneering work of Dr Paul Tessier in Paris during the mid-1960s, using a multidisciplinary team approach has allowed for more radical treatment of these abnormalities with an acceptable morbidity rate within established craniofacial units (Munro, 1975).

Stimulation of human monocyte oxidative burst and related cytotoxicity by tumor-promoting and non-tumor-promoting diterpene esters, indole alkaloids and polyacetate-type agents.

Human peripheral blood monocytes were cultured and exposed to plant diterpenes, indole alkaloids and polyacetates with various degrees of tumor-promoting activity. The effect of the above-mentioned encounter on monocyte function was examined, as expressed by H2O2 production and lysis of dog erythrocytes by the cells, and the inhibition of 3H-PDBu binding to the monocytes by the various test agents. The most effective reagents in both activation of monocyte function and inhibition of 3H-PDBu binding were 12-0-tetradecanoyl-phorbol 13-acetate (TPA), phorbol 12, 13 dibutyrate, teleocidin, and aplysiatoxin which are known to be strong tumor promoters. Strong stimulation of monocyte function was also exerted by the weak tumor promoters, phorbol 12-retinoate 13-acetate, mezerein and debromoaplysiatoxin. Non-tumor-promoting phorbol diterpenes such as phorbol 12, 13-diacetate, phorbol 12-myristate, phorbol 13-acetate and 4-alpha TPA were 1,000 times less effective than TPA in monocyte stimulation and inhibition of 3H-PDBu binding. These results indicate that stimulation of human monocyte H2O2 production and related cytotoxicity might discriminate effectively between tumor-promoting and non-tumor-promoting reagents.

Woolly-hair nevus: a case report and study by scanning electron microscopy.

Woolly-hair is a congenital defect that produces a localized patch of lightly colored, curly scalp hair. Scanning electron microscopy of the abnormal hairs demonstrates twisting of the hair shaft and abnormal cuticle formation.

Polyamine metabolism in compensatory renal growth.

The aliphatic polyamines, putrescine, spermidine, and spermine, appear to play an important role in many forms of rapid growth including embryonic, regenerative, hormone-induced, and neoplastic. While the exact biochemical function of polyamines is unclear, current evidence suggests they are probably involved in the biosynthesis and accumulation of nucleic acids and proteins. Increased levels of polyamines and their biosynthetic enzymes are associated with augmented kidney growth stimulated by renal mass extirpation, as well as by various hormones, toxins, and carcinogens. These observations are reviewed and additional data is provided pertaining to alterations in polyamine metabolism during compensatory renal growth following unilateral nephrectomy (uni). To further explore the effect of growth stimuli on renal polyamine synthesis, an in vitro system was employed which previously provided evidence for a circulating renal growth factor after unilateral nephrectomy. These in vitro observations underscore the rapid inducibility of ornithine decarboxylase, the rate limiting enzyme for polyamine biosynthesis; illustrate the association of polyamine and nucleic acid synthesis during enhanced kidney growth; and support the existence of a circulating renal growth regulator which apparently contributes to compensatory responses following loss of functional renal parenchyma.