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Notes: A total of 132 patch tested patients reacted with petechial reactions to cobalt chloride 1 % in petrolatum; 23 were retested with various concentrations of cobalt. In about 60% of those retested the petechial reaction could be reproduced. Histopathological examination showed slight perivascular tymphocytic infiltration, swollen endothelium and extravasation of erythrocytes but no signs of vasculitis.It is suggested that in predisposed patients the petechial reaction following patch testing could be the result of primary irritation.

Notes: The effect of the non-calciotropic vitamin D3 analogue MC 903 on psoriasis vulgaris was assessed in a double-blind, placebo controlled trial in 30 patients. Lesions on one side of the body were treated for 6 weeks with a cream containing 10 μ/g, 33 μg//g or 100 μg/g MC 903 and lesions on the other side were treated with the cream base alone, according to a randomized design. Nine of the 10 patients in each treatment group completed the study. MC 903 cream gave a statistically significant decrease in erythema, thickness and scaling of the lesions, compared with the control. Overall assessment of psoriasis after 6 weeks showed moderate or excellent improvement in two of nine patients treated with 10 μg/g, in five of nine patients treated with 33 μ/g, and in seven of nine patients treated with 100 μ/g MC 903. Placebo treatment showed a moderate improvement in only one of the 27 patients. The histopathological picture of the psoriatic lesions corresponded with the clinical changes. The patients reported no adverse reactions, and laboratory tests did not show any significant changes; in particular there was no change in serum calcium levels. These results suggest that the vitamin D3 analogue MC 903 is an effective and safe topical treattnent for psoriasis.

Notes: Seven hundred and sixty-four liver biopsies were performed in 328 psoriatics on treatment with methotrexate or being considered for systemic treatment either with methotrexate or with psoralens and long-wave ultraviolet light. The diagnosis of cirrhosis was established histologically in twenty-one patients. Two patients had cirrhosis in their premethotrexate biopsy and were not given methotrexate. The remainder all showed no signs of cirrhosis or fibrosis in their premethotrexate biopsy. The difference between the methotrexate treated psoriatics and the premethotrexate group was highly significant. Among thirty-nine patients treated for more than 5 years, ten developed cirrhosis (25.6%). Almost all patients were on a divided dose intermittent oral dosage schedule. The cumulative dose of methotrexate, when cirrhosis was first found, ranged from 590 to 8105 mg, with an average dosage of 2200 mg. Other factors contributing to cirrhosis in this study seem to be previous treatment with arsenic, a previous intake of alcohol, and lowered renal function.Data on later serial biopsies from fourteen patients, of which eleven continued to receive methotrexate due to very severe psoriasis, seem to indicate that methotrexate induced liver cirrhosis is not of a very aggressive nature. When evaluated blind no progression was found in most of the later biopsies, and a ‘cumulative cirrhosis index’ composed of the combined gradings for fibrosis, assessment of membrana limitans, fibrous destruction and regeneration showed a tendency to decrease. In three patients the latest of the serial biopsies showed no cirrhosis. The observation period on continued methotrexate therapy ranged from 1 to 7 years. None of the patients with cirrhosis differed from the remaining patients on methotrexate in their laboratory results for evaluating liver damage, and apart from transient increases in serum glutamic pyruvic transaminases no abnormalities were found.The data support the necessity of liver biopsies in the control of psoriatics treated with methotrexate. Liver biopsies should be performed at least in all psoriatics in whom a cumulative dosage of methotrexate exceeds 1.5g. The data also indicate that methotrexate can be continued at least for a while in patients where the indication is strong enough, if the dosage is maintained as low as possible and alcohol consumption avoided.

Notes: Eight accidental kidney biopsies in psoriatics were obtained together with 429 liver biopsies. None of the biopsies showed signs of renal damage. All patients had severe psoriasis, six had been treated with methotrexate for 1-2-6 years, receiving total dosages from 660 to 1757 g.

Notes: Eleven patients with mycosis fungoides (MF) were treated with recombinant alpha-intcrfcron (rIFN-α2a2) in combination with etretinate (seven patients) or alone. One patient, who also received etretinate, went into complete remission and remained without signs of MF after 18 months. Six patients experienced partial remission; one of these was treated with rIFN-α2a alone and was clinically in complete remission, but had still a pteomorphic skin infiltrate. Two patients were non-evaluable, and two stopped therapy due to progressive disease. Five patients discontinued therapy due to side-effects although three had partial remission of their disease. Only four patients received 12 months therapy. The study shows that rIFN-α2a in combination with etretinate or alone can induce remission of MF.

Notes: A radioimmunoassay for detection of Clq-binding IgG aggregates and antigen-IgG antibody complexes is described The assay makes use of solid-phase Clq and 32p-labelled protein A-rich Stphylococcusaureus as an indicator system. Both 19S and heavier IgG aggregates that fixed Clq were detected The sensitivity of the assay permitted detection of heavy (19–25S) IgG aggregates at a concentration of 8 μg/ml or less. The results indicated that detection of IgG in this assay is dependent on the degree of IgG polymerization and the molar ratio between the solid-phase Clq and the IgG polymers. Albumin-anti-albumin complexes, preformed at equilibrium with antibody to antigen molar ratios of 2:1 to 3:1 and at antigen concentrations of 25 to 40 μg/ml. were also detectable using the described radioimmunoassay

Notes: Twenty-four psoriatic patients on methotrexate were studied with liver biopsies and serum measurements of aminoterminal propeptide of type III procollagen (PHI NP). All but one of nine patients with scrum levels of PHI NP above the normal range had liver fibrosis or cirrhosis and no normal liver biopsies were obtained in this group. In contrast, nine normal liver biopsies and two biopsies with minimal fibrosis were found among the 15 patients with normal serum levels of PHI NP. The study indicates that aminoterminal propeptide of type III procollagen can be utilized as a valuable non-invasive marker of fibrogenesis in the liver. This analysis is not specific for the liver, but it seems that the number of liver biopsies probably can be reduced in psoriatics on methotrexate who have normal levels of PHI NP.

Notes: Background  Methotrexate (MTX) -induced liver damage is an important complication in patients treated with this drug for skin disease. Reliable non-invasive monitoring tests would have considerable importance. Objectives  This retrospective study was designed in order to evaluate if serial normal serum levels of amino-terminal propeptide of type III procollagen (PIIINP) might indicate that no significant fibrosis is taking place in the liver, and thereby reduce the need for repeated liver biopsies in psoriatic patients treated with MTX. Methods  The clinical records of 70 patients with psoriasis, who in the years 1989/90 were on MTX and had both a liver biopsy without fibrosis and a normal PIIINP, were examined and followed until the patient stopped taking the drug. The follow-up time was from 1 to 11 years. Results  A total of 189 liver biopsies and 329 analyses of PIIINP were recorded. Twenty-one patients had only one and no further biopsies, but their data included at least two to three PIIINP samples obtained within a year around the time of the biopsy, and at least two were taken either prior to or at the time of the biopsy. The remaining patients had from two to seven liver biopsies each and a total of 267 analyses of PIIINP. In the study period only four patients developed fibrosis of the liver as shown by liver biopsies, and all four of these patients developed elevated serum PIIINP levels. In addition two further patients, one of them with psoriatic arthritis, had elevated PIIINP, but normal liver biopsy. Thus no liver fibrosis was missed in the 63 patients with consistently normal PIIINP levels. Conclusions  Present data support the view that, as long as PIIINP is consistently normal in serial investigations, there is minimal risk of development of substantial liver fibrosis.

Notes: Summary A soft, elastic snout-shaped outgrowth, covered by normal skin and containing a central firm cord, was encountered in a 1-month-old girl. The malformation, which was removed by operation, was presumed to be an excrescence from the axis of the maxillary branchial arch, and thus unrelated to previously reported cases of teratomata arising from the clefts of the skull and the fusion of the branchial arches.