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Ninety adult patients with acquired immunodeficiency syndrome (AIDS) and 27 with AIDS-related complex were seen consecutively, when available, either as inpatients or in AIDS clinics and given complete cutaneous examinations. Skin disease was common both in patients with AIDS and in those with AIDS-related complex. The most common cutaneous findings were candidiasis in 55 patients (47.0%), dermatophytosis in 35 (30%), herpes simplex infections in 26 (22%), molluscum contagiosum in 11 (9%), seborrheic dermatitis in 37 (32%), and acquired ichthyosis or xerosis in 36 (30%). Several cutaneous conditions previously reported in association with AIDS were infrequently seen: Psoriasis was seen in only one patient, and deep fungal infections and basal and squamous cell carcinomas were seen in none. No significant differences were noted in the prevalence of skin disease between patients with AIDS and those with AIDS-related complex, although xerosis and ichthyosiform skin changes tended to be more common in those with AIDS. The yellow nail syndrome and "a papular eruption" associated with AIDS were seen. Skin diseases also tended to be widespread and severe in the patients studied.

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A 63-year-old man with a premalignant fibroepithelioma of Pinkus on the base of his penis is presented. Penile premalignant fibroepitheliomas have not, to the best of our knowledge, been previously described. Because fibroepithelioma of Pinkus is a morphological variant of a basal cell epithelioma, we believe that clinically benign fibroma-like lesions appearing on the penis should be biopsied to rule out the presence of this premalignant lesion.

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Proliferating rat smooth muscle cells and fibroblasts have membrane-associated protease activity. High concentrations of heparin inhibited membrane-associated protease activity and cell proliferation, while low concentration of heparin promoted smooth muscle cell proliferation. The inhibition of protease activity and proliferation was abolished when heparin was treated with protamine sulfate or when acid treated fetal calf serum was used. Heparin required the presence of an acid labile factor(s) in serum for the inhibition of protease activity and proliferation. Heparin and antithrombin III in the presence of acid-treated fetal calf serum did not inhibit cell proliferation or protease activity. Cartilage factors isolated from bovine nasal cartilage containing trypsin inhibitory activity, but not papain inhibitory activity, inhibited rat smooth muscle and fibroblast proliferation and surface associated protease activity. The cartilage factors did not require acid-labile components in the fetal calf serum for the inhibitory activity. The inhibitory activity due to heparin and cartilage factors was not permanent under our experimental condition. Protein synthesis was not inhibited by heparin or the cartilage factors. In rat smooth muscle cells and fibroblasts, the expression of surface-associated protease activity was related to the proliferative state of the cells. Surface protease activity was only present on proliferating cells. When surface protease activity was inhibited by high concentrations of heparin in the presence of an acid-labile serum component(s) or cartilage factors, cell proliferation was also inhibited.

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The directly observed, continuous case conference is studied in depth as a format for teaching child psychotherapy. The effects of group dynamics, direct observation, and the specific case on the processes of therapy, learning, and supervision are examined. Six guidelines are set forth to maximize the effectiveness of the conference.

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Three children with bullous erythema multiforme and 1 with toxic epidermal necrolysis associated with antiepileptic drug therapy are described. One patient is unique because of seven mucocutaneous eruptions caused by three classes of antiepileptic drugs. Lymphocyte stimulation by antiepileptic drugs could not be demonstrated in the 2 patients in whom appropriate studies were performed, and no precipitating antibodies to antiepileptic drugs were found. Observation of four diagnostic and therapeutic principles, which are illustrated by the course of our patients, may reduce the incidence of life-threatening mucocutaneous eruptions and simplify the long-term management of individuals in whom such reactions occur.

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A proteinase (EC 3.4.-.-) active at physiological pH has been isolated from human skin utilizing gel filtration and affinity chromatography techniques. The proteinase has a molecular weight of approx. 28 000 and it is inhibited by alpha 2-macroglobulin, alpha 1-antitrypsin, C-1 inactivatory, soybean trypsin inhibitor and diisopropyl fluorophosphate. 2njection of 1 ng of purified proteinase into rabbit skin induces polymorphonuclear leukocyte infiltration of the cutis. Inhibition of enzyme activity with diisopropyl fluorophosphate inhibits the chemotactic effect. Addition of 0.2 microgram/ml of purified proteinase to fibroblast cultures kills the cells within minutes. This proteinase may play a significant role in modulating the inflammatory response after cellular injury.

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A sensitive method for measuring cell surface and secreted protease activity utilizing 3H-labelled casein is described. The method is based upon proteolytic degradation of the casein substrate into trichloracetic acid soluble 3H-labelled peptides. Utilizing the radioassay we found that all cultured cell lines examined contain cell surface proteolytic activity which is not secreted into the media. The protease activity was found to be due to protease(s) other than plasminogen activator or plasmin. A comparison of surface protease activity of normal and transformed mouse epidermal cells indicated that the transformed cells contained approximately 3--1 times more proteolytic activity than the normal cells. Surface protease activity was also correlated with the doubling times of various cultured cells. The results indicated that cultured cells with doubling times of greater than three days possess less surface protease activity than cells with shorter doubling times. In order to determine changes in the levels of surface protease activity during the cell cycle several cell lines were synchronized. In synchronized rabbit aortic fibroblasts, mouse transformed epidermal cells and human melanoma cells, a marked increase in surface protease activity was observed during or before mitosis. The protease levels decreased following mitosis. The results suggest that in culture, cell surface protease(s) may be important factor in regulating the rate of cell growth.

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