Antibodies to the constitutive 73-kd heat shock protein: A new marker of mixed connective tissue disease?

Antibodies to the constitutive 73-kd heat shock protein: A new marker of mixed connective tissue disease?

Journal of the American Academy of Dermatology Pearls of wisdom Volume 33, Number 2, Part 1 261 Abstracts from the literature pa- be important t...

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Journal of the American

Academy of Dermatology

Pearls of wisdom

Volume 33, Number 2, Part 1

261

Abstracts from the literature pa-

be important to validate clinical suspicion of Lyme borreliosis.

A, Rachcka H, et al. South

Robert A. Schwartz, MD, MPH

Impact of unfunded research thology and surgery Pearhnan JJ, Borkowski Med J 1995;88:295-9.

in medicine,

The authors evaluated the impact of unfunded medical research, that is, research conducted with no visible means of support. Research contributions from the 10 most cited journals in the fields of internal medicine, pathology, and surgery were evaluated. The majority of contributions were unfunded, specifically, 60% of pathology articles, 62% of internal medicine articles, and 74% of surgery articles. In 1987, funded research articles published received 2961 citations compared with 2368 citations for unfunded articles. Among articles supported by a grant from the National Institutes of Health, the first author of the article was often not the grant’s principal investigator (from only 38.6% to 60.7%). These results indicate that unfunded research plays a major role in medical research. COMMENT:This interesting article evaluates the impact of unfunded research. These rest&s would almost certainly be applicable to dermatology; many articles published in our major journals are unfunded or supported by private practice monies. It would be of interest to see a similar study performed several years from now.

Clay J. Cockerell, MD

Papular-purpuric a characteristic

gloves and socks syndrome: viral exanthem

Stone MS, Murph JR. Pediatrics 1993;92:864-5. A characteristic papular-petechial eruption confined primarily to the hands and feet with sharp demarcation at the ankles and wrists was originally described in adults in 1990. Fever, oral lesions, lymphadenopathy, and leukopenia were often associated. This eruption was subsequently attributed to parvovirus B 19 infection. Seven patients have been described previously, 16 to 36 years of age. These authors describe a 9-year-old girl with this distinct, nonvasculitic condition. The eruption resolved during the subsequent 7 to 10 days with acral desquamation. The classic “slapped-cheek” rash and reticulated eruption of parvovirus B19 never occurred. COMMENT: This distinct papular-petecbial gloves and socks syndrome PPGSS should be considered when we see patients with acral petechiae, erythema, and edema. Recognition of this entity may prevent confusion with more serious diseases, including meningococcemia, Rocky Mountain spotted fever, and Kawasaki disease, thus obviating prolonged hospitalization and intravenous medication. Amy S. Puller, MD

Histochemical and immunohistochemical methods for demonstration of spirochetes skin biopsies

in

Zanconati F, Cattonar P, Grandi G. Acta Derm Venereologica Alpina, Pannonica et Adriatica 1994; 3:99-104. The authors studied filed skin biopsy specimens from cases of erythema chronicum migrans and lymphadenosis benigna cutis to demonstrate spirochetes. Both Warthin-Starry and Steiner and Steiner methods were used. Spirochetes suggesting Lyme borreliosis were detected at the dermoepidermal junction by both methods. The authors consider both effective in demonstrating tissue spirochetes. These two methods, as well as newer immunohistochemical ones, were described and discussed. COMMENT:Direct detection of spirochetes in tissues may

Antibodies to the constitutive 73-kd shock protein: A new marker of mixed nective tissue disease? Mairesse N, Kahn MF, Appelboom 1993;95:595-600.

heat con-

T. Am J Med

Signiticantly elevated titers of IgG anti-heat shock protein 73 are found in patients with rheumatoid arthritis @ < 0.02), systemic sclerosis (p < 0.02), and mixed connective tissue disease (p < O.OOOOOO0l) but not systemic lupus exythematosus or dermatomyositis. Very high titers were present only in patients with mixed connective tissue disease. High titers may be a fairly specific marker for mixed connective tissue disease. Mark V. Dahl, MD