An unusual cause of arthritis.

We present a case of leprosy, an uncommon infection in the United Kingdom, which mimicked features of widely known rheumatic diseases and resulted in subsequent delay of diagnosis.

Hyperventilation-induced asthma: evidence for two mechanisms.

The mechanism by which airway cooling induces airflow obstruction in asthmatic subjects has not yet been established. Using a pair of isocapnic hyperventilation challenges, with a 40-minute interval, we looked for the presence of a refractory period in 19 asthmatic patients (aged 9-18 years). The subjects fell into two groups. The eight in the "non-refractory" group showed less than a 25% reduction in response to the second challenge, but the 11 in the "refractory" group showed at least a 35% reduction. Twelve subjects also performed a hyperventilation challenge after cholinergic blockade with inhaled ipratropium bromide. In five, in whom no refractoriness after hyperventilation was seen, there was a significant protection from cholinergic blockade (p less than 0.05). In these a vagal (cholinergic) reflex seems likely. The remaining seven, who had a refractory period, received no significant protection from cholinergic blockade and therefore no evidence for the presence of any cholinergic mechanism. We conclude that two mechanisms are responsible for hyperventilation-induced asthma, one of which is a vagal reflex while mediator release may be the other.

Objective test for food sensitivity in asthmatic children: increased bronchial reactivity after cola drinks.

Ten asthmatic children with a history of cough and wheeze after drinking a cola drink performed histamine inhalation tests before and 30 minutes after a drink of Pepsi-Cola, soda water, and water on three separate study days. There was no significant change in baseline peak expiratory flow after any of the three drinks. Sensitivity to histamine was increased after the cola drink (p less than 0.005) but was not significantly different after soda water or water. The detection of change in sensitivity to histamine appears to be a simple and effective method of testing for food sensitivity in asthma.

Prazosin, an alpha 1-adrenoceptor antagonist, partially inhibits exercise-induced asthma.

The effect of prazosin, a potent and specific alpha 1-adrenoceptor antagonist given by inhalation (total nebulized 2 mg) was compared with placebo in a double-blind randomized study of 10 atopic asthmatic children. Prazosin significantly (p less than 0.01) reduced the severity of post-exercise bronchoconstriction (maximum fall in peak expiratory flow after exercise 21.4% +/- SEM 6.3% after prazosin compared with 42.5% +/- 7.3% after placebo). This protective action of prazosin suggests that activation of alpha 1-adrenoceptor may be involved in the pathogenesis of exercise-induced asthma either by facilitation of mast-cell mediator release or by direct contraction of bronchial smooth muscle. Prazosin did not significantly change resting bronchomotor tone or histamine-induced bronchoconstriction, suggesting no effect on bronchial smooth muscle contractility.

Tsetse fly reactions to light and humidity gradients.

Tsetse flies are positively phototactic below about 30 degree C and negatively phototactic above it. The flies show a preference for the wet end of a humidity gradient and the bright end of a dorsal light intensity gradient. Studies of activity levels indicate that tsetse flies should aggregate in damp situations where the activity levels is minimal, whereas in practice the flies are distributed throughout the whole of gradient. Analyses of the water and fat content of experimental flies indicates that the reactions of individual flies is determined by their physiological condition and the conditions under which the flies have previously been kept. Previous ecological studies on the reactions of flies to humidity and light stimuli need to be reassessed in the light of these findings.

Atypical multicentric reticulohistiocytosis with paraproteinemia.

Two women had multiple subcutaneous nodules that showed features of multicentric reticulohistiocytosis (MR). Neither had joint symptoms. Both had a raised erythrocyte sedimentation rate, an immunoglobulin G paraproteinemia, and raised levels of nonhepatic serum alkaline phosphatase. The skin lesions have been followed up, using light and electron microscopy, immunoperoxidase, and histochemical methods. The material in the giant cells stained positively for gamma heavy chain determinants: the light chain type in each case was that of the paraprotein. An attempt to reproduce the skin lesions in one patient by intradermal injection of her paraprotein failed.

Cement burns.

Four cases are presented of men who sustained burns after contact with premixed concrete. The pathogenesis of the condition is discussed.