Charles L. Heaton

DEMONSTRATION OF BASAL CELL IMMUNOFLUORKSCENCE IN DRUG-INDUCED TOXIC EPIDERMAL NECROLYSIS

Summary.— In 2 patients with toxic epidermal necrolysls due to penicillin and chlorpromazlne respectively, direct immunofluorescent studies revealed intercellular fixation of immunoglobulins and complement globulins confined to the basal cell Kiyer of the epidermis. These findings suggest that the drug binds to intercellular epidermal protein and that the basal cells are the target site of cellular damage in drug‐induced epidermal necrolysls.

Chancroid: alias the soft chancre.

Bassereau first differentiated the chancre indure (ulcus durum, hard chancre) of syphilis and the chancre non-indure (ulcus molle, chancre mou, soft chancre) of chancroid in 1852.1 Subsequently, the causative organism was identified by Ducrey in 1889.2 Not until the early twentieth century were Kochs postulates satisfied, and chancroid was accepted as a venereal disease caused by Ducreys bacillus.

Angioid streaks and systemic disease

A review of angioid streaks is presented. Their frequency of occurrence and relation to certain disorders are discussed. They are most commonly seen in pseudoxanthoma elasticum, Pagets disease of bone and sickle cell anaemia. The basic defects of these diseases are examined. It is concluded that angioid streaks may be a manifestation of certain mesodermal tissue disorders, all of which manifest vascular abnormalities. The presence of angioid streaks in a patient demands a thorough investigation for underlying connective tissue disorders.

Treatment of Chlamydia trachomatis infections: comparison of 1- and 2-g doses of erythromycin daily for seven days

Erythromycin is recommended as the alternative to tetracyclines for the treatment of Chlamydia trachomatis infections. However, the usual dose of erythromycin (2 g daily for a week) is frequently associated with gastrointestinal side effects. The goal of this study was to determine whether 1 g of erythromycin daily for a week would be as effective as the 2-g daily dose but without the adverse gastrointestinal effects associated with the larger dose. A total of 114 patients were entered into a randomized double-blind study; 76 patients completed treatment, 13 patients discontinued treatment because of adverse effects, and 25 failed to complete therapy or to return after treatment was initiated. Twelve (27%) of the 45 patients treated with 1 g of erythromycin had cultures positive for C. trachomatis after therapy, as compared with three (10%) of 31 patients treated with a 2-g dose. Only 34% of those treated with 1 g of erythromycin developed adverse gastrointestinal effects, as compared with 71% of those who received 2 g of the drug. Of the 13 patients who discontinued treatment because of side effects, 11 were receiving the 2-g dose. This study indicates that the smaller 1-g dose of erythromycin is inadequate therapy for C. trachomatis infections and that the standard 2-g dose is frequently associated with adverse effects that require discontinuation of therapy.

The revival of nitric acid for the treatment of anogenital warts

The destruction of small lesions by tissue denaturation (fixation) rather than erosion (acid hydrolysis) is accomplished by nitric acid of moderate strength in which nitric acid reduction products are generated by nitric acid oxidation of added organic acids. Such solutions show a temperature‐dependent increase or loss of nitrite during storage, with loss of therapeutic activity when nitrite levels decrease after storage at cooler temperatures. Use of a preparation technique that completely consumes all the oxidizable organic components added to generate nitrite results in a stable preparation that is effective, well tolerated, and convenient in the treatment of anogenital warts (condylomata acuminata). Of 50 patients monitored after treatment with a 6.6 mol/L nitric acid preparation with no residual oxidizable organic agents, results were good in 39 patients, satisfactory in four patients, and unsatisfactory in seven patients. These observations lead to a simplified stable preparation of modest nitric acid concentration with adequate nitrate reduction products for efficacy in the topical ablation of small skin lesions such as condylomata acuminata.

Scar biopsy in sarcoidosis.

Scar biopsies were performed on 25 patients with clinically established and histologically confirmed systemic sarcoidosis. Although none of the biopsied scars had undergone tumefaction and redness, th

Acrocephalosyndactyly: Report of a case, with review of the literature

Abstract A patient with typical Aperts syndrome (acrocephalosyndactyly) is described and the literature reviewed. The two major abnormalities noted are central facial dysplasia and syndactyly of the hands and feet. Other developmental defects have been reported in association with this syndrome but our patient had only secondary ophthalmologic problems.