Victor Horsley (1857-1915) and National Insurance.

The Liberal government in 1911 was determined to improve the health care of the poor and working class in Britain. The Chancellor of the Exchequer, Lloyd George, introduced a National Insurance Bill before Parliament without consulting the medical profession. The doctors were furious but Horsley, a progressive liberal, was firmly in favour of a national health service and vociferously supported the bill.

Victor Horsley (1857-1916) and the temperance movement.

For nearly all of his life Victor Horsley campaigned against the evils of alcohol. This led him into direct conflict with politicians, brewers, publicans and the army. His views are of interest today when the subject of excessive consumption of alcohol is the subject of great public concern.

Victor Horsley (1857-1916) in World War I.

In 1914 Victor Horsley, 56 years old, pioneer neurosurgeon, politician and ardent supporter of the temperance movement volunteered for active service. After a brief period in France he was posted to the Middle East, initially to Egypt and then to Mesopotamia. There he witnessed the horrors of that campaign.

T-cell receptor repertoire in pyoderma gangrenosum: evidence for clonal expansions and trafficking.

Background: The cause of pyoderma gangrenosum (PG) is unknown, but it is likely to be an immune-mediated disease because it is often associated with conditions such as inflammatory bowel disease and rheumatoid arthritis. T cells play an important role in these conditions and have been implicated in the pathogenesis of other skin diseases such as psoriasis.

Objectives: We examined the T-cell receptor repertoire in PG in order to test the hypothesis that if the T cells were responding to antigen, there would be expanded T-cell clones in the skin and the circulation of these patients.

Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial.

Background: Pyoderma gangrenosum (PG) is a chronic ulcerating skin condition that often occurs in association with inflammatory bowel disease. There have been a number of reports of PG responding to infliximab, a monoclonal antibody against tumour necrosis factor alpha.

Aim: In the first randomised placebo controlled trial of any drug for the treatment of PG, we have studied the role of infliximab in this disorder.

Association of parental eczema, hayfever, and asthma with atopic dermatitis in infancy: birth cohort study.

Objective: To evaluate the association of parental history of atopic disease with childhood atopic dermatitis, and to examine the relative strength of associations with maternal and paternal disease.

Design: Mothers were recruited to the Avon longitudinal study of parents and children (ALSPAC) from the eighth week of pregnancy. Before parturition, both parents were asked, separately, to report their lifetime history of eczema, asthma, and hayfever.

Medical outpatients: changes that can benefit patients.

This article reviews the current literature relating to medical outpatient services. It has been produced as part of the RCP/NHS Confederation working party on outpatients departments. The article deals with surveys of patient views on outpatients, suggested ways of improving the service, and how best to accommodate teaching in this setting.

A prospective study of the prevalence and incidence of atopic dermatitis in children aged 0-42 months.

Background: There is strong evidence that the incidence and prevalence of atopic diseases is increasing. However, estimates of the prevalence of atopic dermatitis (AD) have varied greatly in the U.K.

Twice-daily vs. once-daily inpatient dithranol for psoriasis.

The aim of this study was to compare the efficacy and tolerability of twice-daily vs. once-daily regimes of dithranol (anthralin) in Lassar's paste. Over a 4-year period, 61 inpatients with stable plaque psoriasis gave informed consent and entered a randomized controlled trial, having twice or once-daily application of dithranol in Lassar's paste as part of otherwise standard Ingram's regime.

Polymorphic eruption of pregnancy developing in the puerperium.

Polymorphic eruption of pregnancy is an uncommon disorder, usually developing in the third trimester and rapidly resolving in the first few weeks postpartum. It has been suggested that multiple pregnancy and excessive weight gain are associated features. We report a patient with the clinical and histological features of polymorphic eruption of pregnancy, whose rash developed 4 weeks after delivery of a singleton pregnancy.

Polymorphic light eruption limited to areas of vitiligo.

Two patients are described with clinical and histological features of polymorphic light eruption (PLE) limited to areas of vitiliginous skin. This phenomenon has not been reported previously and provides evidence for the protective role of melanin in PLE.

The gene for hypotrichosis of Marie Unna maps between D8S258 and D8S298: exclusion of the hr gene by cDNA and genomic sequencing.

Hypotrichosis of Marie Unna (MU) is an autosomal dominant hair-loss disorder with onset in childhood. A genomewide search for the gene was performed in a large Dutch family using 400 fluorescent microsatellite markers. Linkage was detected with marker D8S258, and analysis of this family and a further British kindred with additional markers in the region gave a combined maximum two-point LOD score of 13.

Recurrent molecular abnormalities in type VII collagen in Southern Italian patients with recessive dystrophic epidermolysis bullosa.

In this study we searched for mutations in the type VII collagen gene (COL7A1) in 10 families from Southern Italy with severe generalised recessive dystrophic epidermolysis bullosa using PCR amplification of genomic DNA, heteroduplex analysis and direct nucleotide sequencing. Our principal aim was to identify any recurrent mutations in COL7A1 that might facilitate future mutation detection strategies in this population. Three recurrent COL7A1 mutations were delineated in six of the 10 families: a frameshift mutation in exon 4, 497insA, was detected in three affected individuals from three families, a deletion mutation at the acceptor splice site of intron 114/exon 115, 8441-14del21, was found in five patients in three of the families, and an intron 49 acceptor splice site mutation, 4783-1 G-to-A, was identified in three subjects in two families (GenBank accession no, L02870).

The molecular basis of inherited disorders of keratinization.

Inherited disorders of keratinization can result in a wide variety of clinical features. The skin is usually affected with blistering or ichthyosis, but other body systems may be involved. The severity of these disorders varies greatly.

Incontinentia pigmenti: variable disease expression within an affected family.

We report a florid case of incontinentia pigmenti in a neonate in which linear vesiculobullous, verrucous and pigmented lesions were present simultaneously at birth. Histology of a vesiculobullous lesion showed vesiculation with numerous eosinophils in the epidermis, and a sparse infiltrate in the dermis with pigmentary incontinence. The mother of our patient described a streaky linear rash on her legs during her own childhood which resolved spontaneously, in addition to partial anodontia, suggesting that she too has the disease, although previously undiagnosed.

Recurrent mutations in the type VII collagen gene (COL7A1) in patients with recessive dystrophic epidermolysis bullosa.

Mutations in the type VII collagen gene (COL7A1) are known to underlie different forms of the inherited blistering skin disease dystrophic epidermolysis bullosa (DEB). Most COL7A1 mutations are unique to individual families, and therefore it is usually necessary to screen all 118 exons of the gene to determine the molecular pathology in a patient with DEB. This study aimed to identify any recurrent mutations in COL7A1 that might be applicable to mutation-detection strategies in these patients.

Herlitz junctional epidermolysis bullosa: a case report and review of current diagnostic methods.

We report an infant with Herlitz junctional epidermolysis bullosa (JEB) presenting at birth with erosions on the scalp, thigh and periumbilical area in addition to nail abnormalities. Ultrastructural studies demonstrated a split through the lamina lucida with poorly formed hemidesmosomes and no clearly defined subbasal dense plates. Indirect immunofluorescence staining with antibodies GB3 (antilaminin 5) and 19-DEJ-1 (antiuncein) was totally absent.