ACNE VULGARIS—Evaluation of a Medicated Cleansing Pad

Using the technique of simultaneous, symmetrical paired comparisons, a medicated cleansing pad that can be easily used at work or at school as an adjunctive in the treatment of acne vulgaris was evaluated.The experimental pads were significantly beneficial in reducing skin oiliness and in clinical improvement of the acne. Response to standard acne therapy was faster when the pads were used adjunctively, although the significant results seen initially tended to even out as therapy continued.Use of the medicated pads produced no untoward side effects and were well accepted by patients.     

DIAGNOSIS AND TREATMENT OF GLAUCOMA—A Review of Recent Developments

Tonography is helpful in the diagnosis of doubtful cases of chronic simple glaucoma. If also gives a good indication of the status of the disease in a given eye.The most useful miotic in the treatment of glaucoma is still pilocarpine. Carbachol is more potent but must be used in an anhydrous base ointment or in a solution of a wetting agent. DFP (diisopropyl fluorophosphate) produces undesirable side effects because of the hyperreactivity of the ciliary body and iris sphincter which it causes. These can be partly overcome by using pilocarpine first. Diamox is a carbonic anhydrase inhibitor that is effective when given orally. In many cases it produces at least a temporary lowering of tension in glaucomatous eyes, apparently by reducing the secretion of intraocular fluid. Its ultimate value in glaucoma remains to be seen.The cyclodiathermy operation which has been modified somewhat by Weekers has had a recent increase in use but the long-term results have been somewhat disappointing.The importance of early operation in narrow angle glaucoma is becoming more and more apparent. Following iridectomy the wound should be tightly sutured to insure the prompt reformation of the anterior chamber.     

MODERN TREATMENT OF PLACENTA PREVIA—A Study of 234 Cases

Study was made of 234 cases of placenta previa occurring in 48,752 deliveries at one hospital during the period 1947-1956. There was no maternal mortality. The uncorrected fetal mortality rate for all weight groups was 21.4 per cent. The rate varied from 88 per cent in babies under 1,500 grams to 5.7 per cent in babies over 2,500 grams. Initial conservative management to permit gestation to continue as close to term as possible is advisable.Ultimate termination of the pregnancy by cesarean section under spinal anesthesia gave the best results. The incidence of transverse and breech presentations in association with placenta previa was inordinately high. A progressive trend toward more conservative treatment of placenta previa was noted in the present series, with a concomitant reduction in fetal mortality rate.     

CAUSALGIA—PATHOGENESIS AND TREATMENT

Gross and microscopic anatomical evidence indicates that pain fibers involved in causalgia are those distributed to blood vessels—possibly to the arterioles—and that, for the greater part, these fibers constitute part of the general visceral afferent system.Several investigators have reported evidence that injury to a peripheral nerve of such a type as to cause damage to the vasomotor control of any area produces the initial pain in an extremity, and it is predicated that the arteriolar constriction causing the pain is then prolonged by the sensitization of arteriolar smooth muscle to the amount of epinephrine normally in the blood. If the condition is not treated, tissue anoxia occurs to such an extent that irreversible changes take place in the affected area.Treatment of causalgia in the lower extremities is directed toward interruption of either the vasomotor or afferent supply of blood vessels by blocking or excision of the second to fourth lumbar ganglia inclusive with the intervening chains. For the upper extremities, the blocking or disconnection of the second and third thoracic ganglia with interruption of the sympathetic chain between the third and fourth ganglia is considered a feasible method of treatment which does not produce the concomitant disability of Horner''s syndrome.     

A NEW CORTICOID FOR TOPICAL THERAPY—Fluocinolone Acetonide

Sixty-seven patients with chronic and subacute cutaneous lesions of varying long duration that had previously been resistant to topical use of corticosteroid compounds were treated with a cream containing fluocinolone acetonide. To avoid subjective bias, only two classifications were used in appraising results: “complete clearing of treated lesions” and “not effective.”Forty-eight patients had complete clearing of the treated area. Results were best in atopic dermatitis, chronic eczematous dermatitis and nummular dermatitis. Granuloma annulare, dyshidrotic dermatitis of the palms and psoriasis were not affected.In some cases in which there were multiple lesions some of the lesions were treated with fluocinolone acetonide cream and some were treated concurrently with other corticoid ointments or with noncorticoid compounds, either bland or with active ingredients. Fluocinolone was effective in more than twice as many cases as the other agents.In some of the patients with chronic disease it was possible to greatly reduce or discontinue systemic steroid therapy after fluocinolone acetonide became available.No untoward effects were observed.