A case report of dyshidrotic bullous pemphigoid developing after partial anterior circulation ischaemic stroke.

Dyshidrotic bullous pemphigoid is a rare form of bullous pemphigoid that affects predominantly a patient's hands and feet. It has been associated in the literature with neurologic, psychiatric and cerebrovascular disorders. We present an interesting case of this rare skin condition developing in a patient following a diagnosis of partial anterior circulation stroke.

The incidence and outcome of photodynamic therapy for macular degeneration in the Northern region of the UK.

PURPOSE: To assess the patients who have had photodynamic therapy (PDT) in the Northern region of the UK, in relation to the eligibility criteria found to benefit in the TAP study (treatment of age-related macular degeneration with photodynamic therapy study), so as to make an estimate of the number of patients who might benefit from this treatment and to present the outcome of the treatment so far. METHOD: The records and fluorescein angiograms (FFAs) of all patients who had had PDT in the Northern region between 2001 and 2002 were reviewed for compliance with the TAP criteria of >50% classic choroidal neovascularization and >34 letters on the 2 m logMAR Early Treatment Diabetic Retinopathy Study chart. NHS funding has been available in the Northern Region since January 2001 for 'second eye' involvement. A review of all the angiograms performed for exudative macular degeneration in 1 year was also performed. The visual outcome of those patients 1 year from baseline was measured. RESULTS: A total of 82 'second eye' patients were treated between January 2001 and December 2002. This gives an incidence of 65 per 3 million and so about 1300 in the whole of the UK (population 60 million). In all, 238 FFAs were performed on exudative macular degeneration, with 21% being found eligible for PDT. As of February 2003, 54 TAP criteria, macular degeneration patients were 1 year from initial treatment. Of these, 12 had incomplete follow-up and 13 patients had lost more than 15 letters. The responder rate defined as losing <15 letters was 42-13/42=69%. Seven of those who did not make 1-year follow-up had lost more than 15 letters when last seen, giving a responder rate of 54-20/54=63%. CONCLUSION: There may not be as many patients eligible for PDT, using the TAP criteria, as previously hoped. The outcome of treatment appears similar to that found in the TAP study.

Separation of the estrogen-activated growth-regulatory forms of alpha-fetoprotein in mouse amniotic fluid.

We have previously reported that murine fetal alpha-fetoprotein (AFP) incubated for 1.0 h at room temperature in the presence of high concentrations of estradiol (E2) generates a growth-regulatory product designated AFP/E2. Subsequently we developed a bioassay in the immature mouse uterus to measure both the growth-inhibitory and growth-enhancing properties of AFP. In the present study, we have employed this bioassay to monitor each of the amniotic fluid-derived AFP isolates fractionated by various chromatographic and electrophoretic techniques. The objective of this investigation was to partition and isolate the various molecular forms of AFP contained in amniotic fluid and determine whether the growth-regulatory activities resided with one or more of the fractions. AFP was fractionated by three different chromatographic/electrophoretic methods: E2 affinity chromatography, preparative polyacrylamide-gel electrophoresis (PAGE), and high-performance liquid chromatography (HPLC); and one immunoaffinity method: gel-entrapped antibody filtration (GAF). Whereas E2 affinity chromatography separated the biological activity of AFP into inhibitory and possibly enhancing activities, PAGE purification yielded three fractions: an inhibitor, an enhancer, and a fraction without growth-regulatory activity. Immunoaffinity separation yielded an AFP product with only inhibitory activities. In comparison, fractionation by HPLC produced seven AFP fractions in which only three displayed growth-regulatory activities: two inhibitory and one enhancing. After subsequent HPLC rechromatography of these fractions, none displayed any biological activity. Thus, murine AFP derived from amniotic fluid is composed of potential heterofunctional forms that, depending on their relative abundance in the preparation, constitute a mixture capable of either (a) growth inhibition, (b) no effect, or (c) growth enhancement.

Percutaneous (nonsurgical) supported angioplasty in unprotected left main disease and severe left ventricular dysfunction.

A 69-year-old patient with the equivalent of severe, unprotected left main coronary artery disease associated with marked left ventricular dysfunction with ventricular aneurysm who had Class IV angina, underwent supported angioplasty utilizing a total percutaneous approach. The patient tolerated occlusion of his main left coronary artery for a total of 7 minutes without difficulty, during dilatation of left anterior descending and two circumflex lesions. He was discharged the following day, symptom free.

Intravenous streptokinase in acute myocardial infarction at the community hospital: a six-year experience.

The efficacy of intravenous streptokinase in the initial management of acute myocardial infarction was evaluated over a 6-year period in 130 patients admitted to 3 community hospitals. Most patients were admitted within 2 hours of onset of symptoms and received 1.5 million units of streptokinase over a 30- to 60-minute period. Clinical observations and serial creatine phosphokinase-MB were indicative of vessel patency in 115 (88%) of the patients after initiation of thrombolysis. Of this group, 105 underwent catheterization, and recanalization was demonstrated in 97 (92%). Fifty percent of the patients who underwent reperfusion were subsequently maintained with medical therapy; 50% underwent either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. Major morbidity was confined to hematomas; no cerebral bleeding was encountered. There was 1 early death from cerebral thrombosis and 2 late deaths, 1 to cancer and 1 to myocardial infarction. These findings suggest the benefit of intravenous streptokinase thrombolysis in patients with acute myocardial infarction presenting within 3 hours of onset of pain, unless specific potential bleeding problems exist or in the case of certain very elderly persons. In addition, the trial demonstrated the feasibility of triaging patients who have undergone lytic therapy to a central facility for catheterization and management.

Pensioners attending an accident and emergency department.

A three-month prospective study of the 1026 pensioners attending the Accident and Emergency Department (A.E.D.) at Oldham is reported. Although they constituted 9.8% of the total attendance, they formed 36.5% of all admissions. Proportionate admission of males was higher than females. Over half the total admissions were due to medical emergencies, whereas only a quarter were due to injury. Contrary to the general impression, the survey showed that the use of A.E.D. and 999 Emergency services was appropriate. Self-referral rate was high, but most of the old people who tried first to contact their general practitioner succeeded in doing so.