No abstract

The microvascular response of foot skin to minor thermal injury and the skin of the anterior abdominal wall to injury from a needle was assessed by laser Doppler flowmetry in 23 patients with type I diabetes and 21 healthy control subjects. After minor thermal injury mean (SD) maximum skin blood flow was significantly lower in the diabetic group than the control group (0.53 (0-11) v 0-72 (0.10) V, in arbitrary units of flow, respectively, p<0001) and was negatively correlated with the duration of diabetes (r= -0-60; p<0-01). After needle injury a similar pattern of impairment was seen, the peak flow value recorded being significantly lower in the diabetic group than the control group (0.28 (0-10) v 0-41 (0-09) V, respectively; p<0-001) and also negatively correlated with the duration of diabetes (r=-0-61; p<0-01). There was a significant relation between the response obtained at the two sites of injury in the diabetic group (r= + 0-72, p<0O001) but not in the control group. The impairment in response was not related to diabetic control and was not explicable in terms of a reduction in superficial skin capillary density.

In a consecutive series of thirty-six male and female patients referred with severe acne, the effect of 3 months' treatment with placebo or spironolactone (50-200 mg daily) on sebum excretion and clinical and endocrine status was evaluated double-blind. Twenty-six patients completed the study. Abnormal free androgen indices were found in 27% of the original nineteen female subjects. Spironolactone reduced sebum excretion in all female subjects, but there was no correlation between sebum response and androgen status. The clinical response was dose-dependent, with maximum subjective and objective benefit when spironolactone doses of 150-200 mg were used.

The effect of oral spironolactone (200 mg daily) on acne vulgaris has been studied in 21 women in a randomized, placebo-controlled, double-blind crossover study using 3 month treatment periods. Compared with placebo, spironolactone produced significant improvement as assessed by subjective benefit (P less than 0. 001), number of inflamed lesions (P less than 0 . 001) and by an independently evaluated photographic method (P less than 0 .02). There was a fall in sex hormone binding globulin but no significant changes in plasma testosterone and derived free testosterone. Initial plasma androgen levels were no higher in responders than in non-responders, nor did oral contraceptive use appear to affect clinical response. Spironolactone is a useful alternative therapy for women with acne vulgaris.

PROLOGUE:The health of children in the United States poses a paradox. Mortality rates have declined dramatically. Health insurance coverage has improved. Insuring the nation's children has been the focus of much policy activity ever since President Clinton's failed effort to provide universal health coverage. The notion was, if we can't cover everyone, let's at least cover the children. And on the current presidential campaign trail, insuring the children (for eight million or so are still uninsured) has been a popular political topic. Yet as author Paul Wise explores the state of child health today in a sweeping epidemiological "check-up," he finds that because of social trends and medical progress over the past three decades, the threats to children's health have changed so dramatically that many of our current health policies and systems of delivery have been rendered obsolete. Here, Wise proposes a new way of thinking about children's health in this country that could drive policy in important ways. He calls for more focused attention on the role of chronic illness in childhood, on the impact of social determinants in health, and on the striking prevalence of disparities. Policy action is needed to address reforms both in clinical care and in the public health aspects that ultimately drive the health of our children.