Rosemary S. Lever

EXAMINATION OF CLINICAL EXAMINERS

Abstract The poor correlation between the marks awarded in the clinical tests in medicine and surgery, and between the medical clinical test and the written objective paper, suggested the need for more detailed investigations into the reliability of clinical examinations. Two examiners independently marked 29 candidates in a clinical examination in medicine, and the marks awarded were compared. In another examination 28 different students were examined on one short case by two examiners and the examination was recorded on videotape. This was subsequently marked by a further twelve examiners and again on two further occasions by the original examiners. Marks awarded by one examiner often varied considerably from those awarded by another examiner for the same performance. Inconsistency in the same examiner was also evident. This observed variation must be more widely recognised in determining the fate of candidates in clinical examinations.

A controlled trial of house dust mite eradication using natamycin in homes of patients with atopic dermatitis: effect on clinical status and mite populations

In a controlled clinical trial, patients with atopic dermatitis carried out house dust mite eradication procedures on their mattresses, using natamycin or a matched placebo spray, with or without vacuum cleaning, for 4 months. For the two groups that used vacuum cleaning, mite numbers fell significantly both by comparison of mean initial and final numbers and by calculating mean rates of reduction from regression analyses (P < 0.01 in all cases). There were no differences between the groups in the magnitude of the decreases. For the two groups that did not use vacuum cleaning, mite populations remained virtually unchanged. These results indicate vacuum cleaning not natamycin had the major effect on mite eradication.

TOXIC EPIDERMAL NECROLYSIS AND SYSTEMIC CORTICOSTEROIDS

SIR, The use of systemic corticosteroids in toxic epidermal necrolysis (TEN) has been much debated. We report a case which supports our belief that systemic corticosteroids do have a place in the treatment of TEN. if given early in the disease. An 85-year-oId woman was prescribed nitrofurantoin for a suspected urinary-tract infection. Two weeks later she developed generalized erythroderma. and cephalcxin was substituted tor the nitrofurantoin. Her skin subsequently began to denude, and the sudden onset of confusion precipitated her referral to hospital. She had a past history of epilepsy which had been controlled for many yoars by phenytoin. In addition, she had been under our care 4 years previously with a generalized, erythematous maculo-papular eruption thought to be due to cotrimoxazole. Her oniy other medication was bendrofluazide.

An experiment involving substitution of tape-slide programmes for lectures.

Abstract A group of 4th year students were taught part of an endocrinology course by programmed tape-slide presentations in place of conventional lectures. Kindermann audiovisual tutor machines and audio-tape cassette players with automatic hand viewers were used. The students taught in this way significantly improved their positions in the class and reacted favourably to the experiment.

Natural killer cell activity in atopic dermatitis: a sequential study

It is well‐recognized that patients with atopic dermatitis handle certain cutaneous viral infections poorly. As natural killer (NK) cell activity is considered to contribute to the immune response to viral infection, seven young adults with atopic dermatitis had their NK cell function assessed over a 12‐month period. Natural killer cell activity was found to correlate inversely with disease activity. The more active the disease, the greater was the reduction in NK cell function (P<0.01). In addition, a strong correlation between clinical activity and IgE was shown (P<0.001).

Natural-killer-cell activity in atopic dermatitis

Natural‐killer (NK)‐cell activity was measured in the peripheral blood of twenty patients with atopic dermatitis and in a group of thirteen age‐matched non‐atopic controls (nine subjects on thirteen occasions). The method uses a chromium‐release assay with the human leukaemia cell line, K562, labelled with 5lCr as the target cell. A highly significant reduction in NK‐cell activity was found in the patients with atopic dermatitis.

Angiotropic B-cell lymphoma (malignant angioendotheliomatosis): failure of systemic chemotherapy

A 65‐year‐old female with angiotropic B‐cell lymphoma is reported. Despite the absence of systemic involvement on formal staging and the favourable response of the cutaneous lesions to triple systemic chemotherapy with prednisolone, vincristine and cyclophosphamide, postmortem findings showed that death was due to widespread disease dissemination.

Latex allergy in atopic children.

The incidence of positive circulating specific immunoglobulin E (IgE) antibodies to latex and evidence of clinical latex sensitivity appears to be increasing since its first description in 1979. Although heightened medical awareness may be a factor, exposure to latex products, particularly rubber gloves, has increased since the discovery of the human immunodeficiency virus (HIV). Atopic individuals are at greater risk of developing latex sensitivity. We identified seven children with atopic eczema who were known to have clinically significant latex allergy and examined the relationship of prior exposure to latex gloves. All children had significant serum levels of specific IgE to latex. Before developing clinical symptoms of latex allergy, all had been exposed to latex in the form of gloves during either inpatient or outpatient treatments of their skin. Exposure of atopic individuals to latex gloves could be a major risk factor for sensitization and could increase the incidence of serious reactions.

Protein S deficiency in lupus erythematosus secondary to hereditary angio-oedema.

Summary We report a child with lupus erythematosus secondary to type 2 hereditary angio‐oedema (HAE). Reduced levels of free protein S were found. Total protein S, and C4 binding protein (C4bp) were normal, and there was no evidence of anticardiolipin antibodies or lupus anticoagulant. We postulate that reduced levels of C4, secondary to C1 inhibitor deficiency, resulted in increased binding of protein S to C4bp, leading to reduced levels of free protein S and thus functional deficiency of protein S.

Multiple clear cell acanthomas—treatment by cryotherapy

Clear cell acanthomas (Degos’acanthomas) are usually solitary tumours and an excisional diagnostic biopsy therefore provides effective treatment. Such an approach is, however, impractical in the much rare condition of multiple clear cell acanthomas where up to 30 lesions have been described on one patient.1 We describe a case of multiple clear cell acanthomas in which cryotherapy provided a quick and convenient method of treatment resulting in minimal scarring especially when compared to excision biopsy.