Effects of sleep deprivation on cognitive ability and skills of pediatrics residents.

The stress and long working hours of medical residency have become the basis for controversy over whether current training structures and processes adversely affect residents' skills and well-being and the quality of patient care. The authors measured cognitive and skills performances of 45 sleep-deprived pediatrics residents by using questions like those on the pediatrics board certification examination and using patient-care tasks that required coordination and dexterity. The residents were randomly divided into two groups--one stayed awake for 24 hours, the other for 34 hours--and were tested on cognitive and skills performances before and after sleep deprivation. Sleep deprivation did not have a significant effect on cognitive performance. Of the three skills tested, the residents overall needed more time to perform umbilical artery catheterization, but the group deprived of sleep for 34 hours performed vein cannulation more quickly than the group deprived for 24 hours. Implications for these findings are discussed in the context of the ongoing controversy over the structure and process of medical education.

Autoantibodies to extracellular collagen matrix components in epidermolysis bullosa and other bullous diseases.

In order to determine whether autoantibodies are present in sera from normal individuals and/or patients with selected bullous disorders, a highly sensitive solid-phase radioimmune assay was established using purified native collagen types I-VI, laminin, and fibronectin as substrates. Sixty-four sera were utilized, representing 12 normal controls as well as 4 patients with extensive thermal burns, 18 with autoimmune bullous diseases (11 bullous pemphigoid, 5 pemphigus vulgaris, and 2 epidermolysis bullosa acquisita), and 30 with non-autoimmune mechanobullous diseases [epidermolysis bullosa (EB): 20 simplex, 4 junctional, and 6 dystrophic]. In general, autoantibodies to types I, II and VI collagen and fibronectin were undetectable in any of the patient or control groups. In contrast, autoantibodies to types III and V collagen were noted in 87.5% (28/32) and 90.6% (29/32) of EB sera, respectively, while being only rarely noted in sera from other patient groups. Similarly, autoantibodies to type IV collagen and laminin were detected in 50% (16/32) and 40.6% (13/32) of EB sera, especially from patients with simplex and dystrophic forms of the disease. These data suggest that selected interstitial and basement membrane-associated collagens and laminin may become autoimmunogenic in all three forms of inherited EB in contrast to their relative lack of immunogenicity in at least some of the other intraepidermal and subepidermal blistering disorders. The role, if any, of these autoantibodies in the induction or perpetuation of blistering in EB awaits further studies.

Topical minoxidil for male pattern baldness.

Significant hair growth occurred in 53% of the 81 patients completing a 1 year trial of topical minoxidil. The average reduction in the diameter of the balding crown was 3.48 cm for all patients. There were no minoxidil related changes in laboratory tests during the study period. Psychosocial studies of our patients indicate that 95% assessed the effectiveness of topical minoxidil as moderate or excellent. The majority of those participating in the study thought that their personal presentation of self was of equal or greater importance than their work performance. It was concluded that topical minoxidil has the potential to improve male pattern baldness significantly without apparent risk and to be a means by which individual presentation of self may be improved.

Photosensitivity in infants and children.

Childhood photosensitivity diseases may encompass many of the diseases seen in adults. In addition, there are a number of photosensitivity diseases that are exclusive to children, including both acquired and congenital or genetic syndromes. These syndromes and their etiologies, when known, are discussed.

Hair loss. Common congenital and acquired causes.

Hair loss is a common problem likely to be encountered by a clinical practitioner. The most frequent causes of hair loss in pediatric patients include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. In the adult population, causes to be considered are alopecia areata and hair loss associated with systemic disease and hormonal influence. The clinician must be able to separate the types and causes of hair loss into those that reflect primary dermatologic conditions and those that represent reaction to systemic disease.

Toxic epidermal necrolysis in a 6-week-old infant.

Toxic epidermal necrolysis was documented in a 6-week-old infant with Klebsiella pneumoniae sepsis who received many medications. We inoculated infant mice with the K. pneumoniae isolate but were unable to produce histologic changes resembling those seen in our patient. This condition should be included in the differential diagnosis of severe drug reactions in very young infants with clinical scalded-skin syndromes.

Human absorption of crude coal tar products.

Five normal adult volunteers without cutaneous disease applied 2% crude coal tar to the skin for eight-hour periods on two consecutive days. Blood extracts subjected to gas chromatography and mass spectrometry yielded evidence of absorption in all five volunteers. Phenanthrene, anthracene, pyrene, and fluoranthene, found in four of our volunteers, have been shown to be tumor initiators or cocarcinogens.

Use of high-resolution open tubular glass capillary columns to separate acidic metabolites in urine.

We used high-resolution glass capillary columns to study the trimethylsilyl derivatives of some acidic metabolites found in pooled urine specimens form control and postpartum subjects. About 30 compounds were identified by gas chromatography-mass spectrometry-computer techniques. In general, open tubular capillary columns effect better resolution of trimethylsilyl derivatives of organic acids than do conventional packed columns. GESE-30 proved to be a good general-purpose stationary phase, whereas OV-17 offered certain advantages in resolving aromatic acid components.