Industrial exposure to organophosphorus compounds. Studies of a group of workers with a decrease in esterase-staining monocytes.

When an automated counting instrument using an esterase stain was employed, decreased monocyte counts were observed in a group of process workers exposed to organophosphate esters. Their monocyte counts were not found to be depressed with manual counting or with an automated counter using another staining method. The apparent depression was transient. In these workers and a comparison group, theoretical adverse consequences of decreased monocyte esterase and also possible changes in other esterases were explored. No anergy was seen with mumps or staphylococcal phage lysate hypersensitivity skin tests. Histology of the mumps reaction was similar in both groups. The depressed monocyte counts were significantly associated with a mild reduction in erythrocyte cell acetylcholinesterase, but no reduction was seen in plasma pseudocholinesterase or lymphocyte neurotoxic esterase.

Urticaria.

Urticaria/angioedema is very common and usually not very serious. The main diagnostic task is the history, asking about pharmaceutical agents, foods, focuses of infection, physical agents, and psychogenic factors as well as inhalants, insect bites, internal diseases, immune complex diseases, contactants, and genetic factors. The main therapeutic tool is to eliminate the offending agent. If this cannot be done, therapy should begin with an H1 antihistamine pushed to tolerance or clearing. Life-threatening laryngeal edema and/or anaphylactic shock are extremely rare. Laryngeal edema is usually a component of hereditary angioedema. In such cases, subcutaneous epinephrine is the drug of choice. Laboratory investigation in chronic urticaria should include CBC, erythrocyte sedimentation rate, and a serum multiphasic analysis. A myriad of laboratory tests can be done in chronic urticaria, but some cost-yield effective ones are a test for antinuclear antibodies and x-rays of the sinuses and dentition.

The immunobiology of basal cell carcinoma: an in situ monoclonal antibody study.

A semi-quantitative, immunoperoxidase monoclonal antibody technique was used to study the mononuclear cells surrounding 32 basal cell carcinoma specimens from 30 patients. Tumours were analysed in subgroups based on recurrence, size and ulceration. T cell counts were high (greater than 3 out of 4) for all groups while T helper/inducer and T suppressor/cytotoxic cell counts were equal (approx. 2). Macrophage counts were low for all groups, about I X 2, while B cell and Ia positive cell counts were high (greater than 3). T/B cell and T helper/suppressor cell ratios approached one for the tumours as a whole as well as the sub-groups. The relative importance and contribution of cell mediated vs. humoral immunity in keeping basal cell carcinomas in check is discussed.

Characterization of the inflammatory infiltrate in lupus erythematosus lesions using monoclonal antibodies.

The inflammatory infiltrates of cutaneous lupus lesions from 14 patients with benign cutaneous, subacute cutaneous or systemic lupus erythematosus were examined for T and B lymphocytes, macrophages and Ia positive cells using monoclonal antibodies and a peroxidase antiperoxidase technique. T cells and Ia positive cells were present in abundance followed by B cells then macrophages. Approximately equal numbers of helper/inducer T cells (OKT4, Leu3a) and suppressor/cytotoxic T cells (OKT8, Leu-2a) were present in the inflammatory infiltrate.

Serum autoantibodies in systemic lupus erythematosus and correlation with cutaneous features.

Eighty-eight untreated systemic lupus erythematosus patients collected from rheumatology services were studied for the presence of discoid, molar and vasculitic lesions and photosensitivity. Their sera were examined for antibodies to native deoxyribonucleic acid (nDNA), nuclear ribonuclear protein (nRNP), the non-nucleic acid nuclear macromolecule Sm, the nuclear and cytoplasmic macromolecules La(SSB) and the predominantly cytoplasmic macromolecule Ro(SSA). These studies demonstrated that 42% of the lupus patients possessed nDNA; 36% nRNP; 24% Ro(SSA) and 9% anti La(SSB) antibodies. Six patients failed to demonstrate significant antinuclear antibody titers (mouse liver substrate), and 4 of these possessed anti Ro(SSA) antibodies. Correlation to the cutaneous lesions among this lupus population possessing various serum antibodies revealed a trend toward photosensitivity and molar dermatitis in the Ro(SSA), La(SSB), Ro/la and the ANA negative, ANA negative/Ro positive groups of lupus patients.

Bullous scleroderma.

Bullae arose in two patients with scleroderma and in one patient with a similar condition, eosinophilic fasciitis. Biopsy specimens from two of the patients demonstrated prominent dermal lymphatic dilation. We hypothesize that these lesions occurred after the development of lymphatic obstruction secondary to dermal sclerosis.

Urticaria. An immunofluorescence and histopathology study.

Fourteen randomly chosen patients with "garden variety" urticaria were studied for the presence of vasculitis and immunoglobulins and complement. Results of direct immunofluorescence (DIF) of the involved skin were negative, although two patients had immunoglobulins and complement demonstrable in the cytoplasm of the epidermal cells. Results of DIF of uninvolved skin were also predominantly negative. Findings from serum samples tested by indirect immunofluorescence (IIF) were negative, except for one positive in low titer (1:10, the basement membrane zone). Serum C3 and C4 levels were normal in five patients, both levels were low in two, and the C4 level was low in one patient. No skin-reactive immunoglobulins were found in these three patients by DIF or IIF. The ESR was measured and found to be elevated in four patients. Results of immunofluorescence proved negative in these cases. Of the 12 patients studied by hematoxylineosin staining to determine histology, none exhibited vasculitis. We believe that vasculitis with antigen-antibody reactions is not the rule in "garden variety" urticaria.