Increased activity of serum amine oxidases in granuloma annulare, necrobiosis lipoidica and diabetes.

Serum monoamine oxidase, diamine oxidase and lysyl oxidase-like activity were measured in patients with granuloma annulare (GA), necrobiosis lipoidica (NL) and diabetes mellitus. In diabetes, all enzyme measurements were raised by a factor of about 2 X 2, and in NL by a factor of about 1 X 5. The rise in patients with GA was small and only significant in the case of benzylamine monoamine oxidase. "Stiff' collagen would seem to link these three disorders and the present results suggest that these amine oxidases could be useful in monitoring collagen abnormality in diabetes and diabetes-associated disorders, particularly in the absence of chronic liver disease. A negative correlation was found between enzyme activity and blood glucose levels, thus collagen changes in these conditions may occur independently of elevated blood glucose levels. Possible involvement of these enzymes in angiopathy remains to be elucidated.

Accumulation of sorbitol in endothelial cells--a possible cause of diabetic microangiopathy.

Human umbilical cord endothelial cells accumulate more intracellular sorbitol in response to increased glucose concentration during in vitro incubation. This accumulation of sorbitol by endothelial cells is both concentration and time dependent. Increased concentration of sorbitol in endothelial cells may be important in the pathogenesis of diabetic associated microangiopathy.

Photocontact urticaria from chlorpromazine.

Chlorpromazine is well recognized as a cause of delayed photosensitive eczema. A patient illustrated typical features of the phenomenon. Urticarial lesions were also elicited on photopatch testing.

In situ saphenous vein bypass for occlusive disease in the lower extremity.

In situ saphenous vein bypass, using the new valve incision techniques, has shown great promise in the early clinical trials to date. This procedure allows disruption of the venous valves without removal of the vein from its bed, thus allowing preservation of the vasa vasorum and maintenance of the endothelial integrity of the veins. This has allowed an overall improvement in the patency rates of the lower extremity bypasses, particularly in the bypasses to the infrapopliteal position. Also, and perhaps most important, it has permitted the use of smaller veins, with a minimum diameter of 2 mm. This greatly increases the number of patients who can benefit from such a vein bypass since reversed vein bypasses previously have required veins to have a minimum diameter of 3.5 to 4 mm. Long-term follow-up of in situ bypasses is not yet available. However, if the encouraging preliminary results of these bypasses are substantiated on long-term follow-up, in situ saphenous vein bypass may well become recognized as the procedure of choice for lower extremity bypass.

Response of male acne to antiandrogen therapy with cyproterone acetate.

The antiandrogen cyproterone acetate, which is known to suppress sebum production, but is not a standard therapy, was given in combination with tetracycline to 63 young unmarried men who had failed to respond to 6 months' tetracycline therapy alone. Fifty-seven patients responded and the mean time to clearance was 5.2 months' therapy. The main side effects were nodular sub-nipple breast swellings, which occurred in 13 cases (21%). Such side effects were reversible and cleared after 3-4 months following cessation of therapy. Eighty-eight percent of patients relapsed within 3 months of discontinuing therapy.

Diabetic serum stimulates the proliferation of endothelial cells in culture.

Pooled serum from insulin dependent or non-insulin dependent diabetics stimulated the proliferation of endothelial cells in culture. This potentiating effect was observed only during the growth phase, but not when confluency was reached. Both diabetic and control endothelial cells proliferated normally in control serum.

In vitro production of IgE and IgG protein by blood mononuclear cells from non-atopic and atopic donors.

The production of IgE and IgG protein by human peripheral blood mononuclear cells in culture has been examined. Cells obtained from 18 grass-sensitive donors during the grass pollen season and from 11 atopic dermatitis patients (total serum IgE levels greater than 960 ng/ml), spontaneously produced significant amounts of IgE but not IgG with time. Similar results were obtained using B-cell enriched preparations from both groups. Cells from 16 non-atopic donors had mean levels of pre-formed IgE similar to those of grass pollen-sensitive donors, but there was no increase in culture IgE with time. Treatment of mononuclear cells with pokeweed mitogen did not influence the production of IgE but markedly increased the amount of IgG synthesized by non-atopic and atopic donor cells. Slight, but significant increases in culture IgE, but not IgG, were seen following a 7-day mixed lymphocyte reaction involving both unrelated non-atopic donor cells and the lymphoblastoid B-cell line, Raji. Treatment of cells with 50 HA units of influenza A/Hong Kong/1/68 (H3N2) virus or with 0.02% v/v (240 IU/ml) of a purified beta-interferon preparation did not alter IgE or IgG produced.

Increased macrophage activity in psoriasis.

Macrophages derived from circulating blood monocytes of psoriatic patients demonstrated an enhanced release of beta-glucuronidase and lysozyme compared with macrophages from healthy subjects. The relationship of cell activation to the pathogenesis of psoriasis is discussed.

Increased ratio of helper to suppressor T cells in alopecia areata.

We studied lymphocyte subsets in the blood of twenty-four patients with alopecia areata of various degrees of severity. There was an increase in the ratio of helper to suppressor cells that correlated with the extent of the disease, providing further evidence that the immune system may be involved in its pathogenesis.

Polymorphonuclear and mononuclear leucocyte function in necrobiosis lipoidica and granuloma annulare.

Neutrophils and monocytes from patients with necrobiosis lipoidica (NL) and granuloma annulare (GA) were studied in vitro in order to detect functional abnormality. Phagocytosis of latex particles and zymosan-induced release of beta-glucuronidase were similar in patients and controls. Plasma from these patients did not enhance or inhibit phagocytosis or enzyme release from normal cells. Our studies suggest that peripheral blood leucocyte function in patients with GA and NL is normal, but this does not exclude a functional abnormality in the lesions.