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Background Dyschromatosis symmetrica hereditaria ( DSH) is characterized by the presence of hyperpigmented and hypopigmented macules mostly on the dorsal aspects of the extremities. Mutations in the adenosine deaminase acting on RNA1 ( ADAR1) gene have been revealed as the cause of DSH. ADAR1 is known to give rise to two protein isoforms (p150 and p110) that differ by the 295 N-terminal amino acids, but the specific roles of its two isoforms in the pathogenesis of DSH are poorly understood. Objectives A Chinese family with typical DSH was screened for mutation of ADAR1, and we aimed to investigate the functional significance of the identified mutation. Methods All exons and adjacent exon-intron sequences were amplified and sequenced. The possible influence of the identified mutation on the functionality of p150 and p110 was analysed using the minigene strategy and dual-luciferase reporter assay, respectively. Results We identified a novel two-base-pair deletion of AG (c.271_272delAG) in exon 2 of ADAR1. The AG deletion caused a frameshift mutation in the p150 isoform, and the mutant p150 transcripts were subjected to nonsense-mediated mRNA decay. However, the deletion mutation did not alter the encoded amino acid sequence of the p110 protein due its position in the 5′-untranslated region of the p110 isoform, and had no significant influence on the expression of p110. Conclusions The results represent the first evidence that the ADAR1 p150 isoform is the determinant of DSH and may give insight into the currently unknown mechanisms involved in the development of DSH. [ABSTRACT FROM AUTHOR]

Background Livedoid vasculopathy, also known as atrophie blanche, is a recurrent painful vasculopathy appearing mostly on the lower limbs. Treatment is challenging and relapses are frequent. Objectives To analyse the long-term effect and safety of hyperbaric oxygen (HBO) therapy in treating livedoid vasculopathy. Methods Twelve patients with active livedoid vasculopathy were included in this study. All patients underwent HBO therapy five times a week. Each week photographs were taken and the total dose of analgesics was recorded. Side-effects were documented and assessed. Recurrence was defined as the presence of skin ulceration. Results Of the eight patients who completed the treatment, resumption of ambulation and reduction of analgesics were achieved at an average of 4·9 HBO therapy sessions. Leg ulcers in all eight patients healed completely at a mean of 3·4 weeks (range 2–5 weeks). Six patients suffered relapses of ulceration and responded to additional HBO therapy. No significant side-effects were found. Conclusions HBO is a relatively safe, fast and effective method to treat patients with livedoid vasculopathy. [ABSTRACT FROM AUTHOR]

Patients with chronic lymphoedema are prone to develop chronic infections and various tumours in the lymphoedematous limb, suggesting that regional immune surveillance is impaired. To test the hypothesis that cutaneous cell-mediated immunity is impaired, 35 women with postmastectomy lymphoedema were investigated using dinitrochlorobenzene to test the efferent and efferent loops of the allergic contact immune response. The results support the role of lymphatics as an important component of the immune response to allergens by the demonstration of impairment of both the different and efferent loops of the allergic contact dermatitis reaction, and confirm that there is suppression of immune competence in a lymphoedematous limb. [ABSTRACT FROM AUTHOR]

The regional distribution of initial (i.e. most peripheral) lymph vessels of the human skin is unknown. New methods permit a precise systematic determination of the density of initial lymph vessels in every region of the dermis. Based on 202 skin specimens, it was possible to investigate the density of the lymph vessels of the skin derived from head. neck. upper arm, forearm, tipper and lower leg. In all regions there seem to be a uniform structured dense subpapillary network and a wide meshed deep dermal network. The lymph vessels are at their most dense in the skin of the head. [ABSTRACT FROM AUTHOR]

Keratoderma with scleroatrophy of the extremities, also referred to as Huriez syndrome, is a rare, autosomal dominant condition, first described in 42 of 132 members of two families from northern France. The term sclerotylosis was proposed because of the pseudosclerodermatous appearance of the hands and digits. The distinctive feature of this syndrome is the risk of the development of squamous cell carcinoma on affected skin. Since the initial description of this disease, three other families, and possibly a fourth, have been reported. In the present study, we reassessed the clinical, pathological and genetic data in 114 members of one of the two original families, of whom 27 were affected by this syndrome. [ABSTRACT FROM AUTHOR]

Four cases of dermal melanocylosis with symmetrical areas of hyperpigmentation involving the face and extremities are reported. Light and electron microscopic studies showed changes similar to those seen in naevus of Ota. [ABSTRACT FROM AUTHOR]

We have recently seen two cases of hyperpigmentation in children, which was reticulate and distributed in a zosteriform fashion. As another two cases of hyperpigmentation of this kind in children have been reported previously, described as reticulate hyperpigmentation distributed in a zosteriform fashion,1,2 this gives a total of four cases of hyperpigmentation of this kind reported recently from Japan. These four cases differed from progressive cribriform and zosteriform hyperpigmentation, the condition which these cases resembled most closely, with respect to the age of onset of the hyperpigmentation, which in the four Japanese cases was not confined to a dermatome. Like a variant of incontinentia pigmenti (IP), all four cases showed eosinophilia. But they differed from IP in that there was no inflammatory stage, no pigmentary incontinence detectable on histology, and no evidence that the condition was hereditary. These four cases do not conform completely to any described entities and we suggest that they represent a new clinical entity. [ABSTRACT FROM AUTHOR]

In a randomized double-blind controlled study, 19 patients applied 5% 5-fluorouracil (5-FU) cream to actinic keratoses (AK) on each arm twice daily, followed by nightly application of 0.05% tretinoin cream to one arm, and a control cream to the other arm until discomfort precluded further applications. After 3 months, the number of residual AK was compared to pre-treatment values. The tretinoin-treated arms had 15.7 ± 6. 1 AK before treatment and 3.4±2.6 AK following therapy. The control arms had 15. 3 ± 6.9 AK before therapy and 4.2 ± 2.5 lesions afterwards. Using a one-tailed paired t-test, the difference in response was statistically significant (0.03 <P< 0.04). It was concluded that daily application of 0.05% tretinoin cream appeared to enhance the efficacy of topical 5-FU in destruction of AK of the arms and may represent a useful treatment modality. [ABSTRACT FROM AUTHOR]

The effect of application site on anthralin inflammation was measured at 10 clinically normal volar skin sites on each forearm of 31 subjects as the increase in skin thickness at 48 h using Harpenden calipers. Pre-treatment and increase in skin thickness were significantly related to application site. Pre-treatment thickness increased distally and laterally by an amount depending on sex, and to a lesser extent other factors, whilst the increase in skin thickness values was greater proximally, laterally and on the right arm but was not affected by age, sex or skin type, When increases in skin thickness values were adjusted for pre-treatment thickness the difference between proximal and distal sites was lost but there was still a significant difference between the medial and lateral aspect and the right and left arms. The absolute differences were small but demonstrate the need to use symmetrical forearm skin sites and randomized treatment sides when comparing the effects of topical agents on anthralin inflammation. [ABSTRACT FROM AUTHOR]

Large numbers of milia were seen in areas of skin affected with bullae in a 68-year-old woman who had extensive lichen scierosus et atrophicus. Although milia are frequently seen in other sub-epidermal bullous disorders, they have not previously been reported in lichen scierosus et atrophicus. Lichen scierosus et acrophicus is an uncommon condition of the skin which predominantly affects the genital region of middle-aged and elderly women. The skin of the trunk and limbs may also be affected with small white macular or atrophic plaques. Occasionally the lesions may spread rapidly to involve up to half the body surface. Bullous lesions are often seen histologically, but less frequently on clinical examination. A patient was seen with extensive lichen sclerosus et atrophicus and is being reported because there were several unusual features, including milia formation. [ABSTRACT FROM AUTHOR]

Three hundred and forty-six West Indian children aged 0 to 11 were examined for mongolian spots and Volgt's lines. The incidence of mongolian spots showed a linear drop with age; they were present In 95%, of children under a year and 3%, of children aged 10. Thus they are common in children over a year. Linear differences in pigmentation along the anterior border of the arm were found in 2%, of the 235 children. [ABSTRACT FROM AUTHOR]

Impressions of the skin surface were taken with silicone rubber and secondary positive replicas were made with Araldite. After coating with gold they were examined with the scanning electron microscope. The openings of the sweat ducts were easily seen on the palms and soles, and each of their orifices was patent. The terminal ducts have also been identified on the surface of skin on the limbs and trunk, and the appearances of these ducts is described. By oblique rotation a patent orifice was identified for each sweat duct, and by sequential cellophane tape stripping it was shown that all the sweat ducts were patent throughout their spiral course in the horny layer. [ABSTRACT FROM AUTHOR]

Two cases of the Morquio syndrome, with associated mucopoly-sacchariduria, are described. Striking cutaneous abnormalities were found in each, the skin being loose, thickened, tough and inelastic particularly at the extremities. Generalized telangiectasia was present especially on the face and limbs Similar changes have frequently been reported in the closely related Hurler syndrome. The presence of common features in the skin in these two conditions indicates that the cutaneous abnormalities of the Hurler syndrome are not uniques [ABSTRACT FROM AUTHOR]

Dermatitis on the anterior aspect of the lower leg (" ocreiform ") is a common condition among Africans in Kenya with distinctive clinical and histopathological features. The relationship between this dermatitis and other chronic eczematous infected conditions of the extremities, notably " dermatitis cruris pustulosa et atrophicans " described in Nigeria is discussed. The predisposing factor in Africans for dermatitis in this localization appears to be an atrophy with similar distinctive features, which was found to be present in a majority of all Kenyans over the age of 5 and is often overtreated by vigorous cosmetic procedures. [ABSTRACT FROM AUTHOR]

The article focuses on the ulcerating and mutilating trophic lesions of the lower limbs. The lesions first appear on the foot which has been subject to trauma and it is only later that the other is affected. When the lesions affect both sides they predominate on the foot where local trauma has been more marked. The lesions are accompanied by characteristic changes in sensation. The temperature sense is progressively blunted at first in the toes and later spreading proximally. Sensation of touch and pain persists or at the most may be partly blunted so that there results a dissociated sensory loss of the kind found in syringomyelia, which lasts throughout the whole course of the disorder.

The article cites a case of a 41-year-old woman who was diagnosed of liquefying nodular panniculitis in the lower extremities. The patient was presented with an ulcer behind the right knee, which she attributed to an infected mosquito bite. She was admitted with unraptured but fluctuant mass over the left deltoid, and unhealed ulcerations that discharge yellowish fluid. The treatment used for this case was chloramphenicol.

The article presents case study for demonstrating effectiveness of ranolazine in treating primary erythromelalgia (PE) which is a rare autosomal dominant neuropathy characterized by a combination of recurrent burning pain, warmth and redness of the extremities. It mentions information on use of ranolazine for reducing neuropathic pain. It presents information on use of carbamazepine monotherapy for long-term pain relief.

Five women affected by androgenetic alopecia developed severe hypertrichosis of the face and limbs after 2-3 months of treatment with 5% topical minoxidil. Minoxidil was discontinued and in all patients the hypertrichosis disappeared from the face and arms after 1-3 months, and from legs after 4-5 months. Systemic absorption of minoxidil, and a high sensitivity to minoxidil of the follicular apparatus in these areas, is hypothesized. [ABSTRACT FROM AUTHOR]

Dowling-Degos disease and Kitamura's reticulate acropigmentation are both rare disorders of pigmentation, which predominantly affect the flexures and the extremities, respectively. A small number of patients with features of both disorders have been described, suggesting that these clinical patterns may be different manifestations of the same disease. We present a further case to support this conclusion. [ABSTRACT FROM AUTHOR]

The article presents a case report on multiple cutaneous immunocytomas and type III cryoglobulinaemia. Since 1977 a 61 years old male patient has suffered from recurrent skin lesions on the trunk and extremities. Some lesions cause local itching but the majority are asymptomatic. Dispersed over both arms, the trunk and the right upper leg, six plaque-like infiltrates of various sizes were found during the examination. Their color ranged from pale blue-gray to brownish red. Recently a reduced threshold to suction-induced blister formation was demonstrated in insulin-dependent diabetics.

This article discusses a case of spasticity and vascular lesions. In the given case, a 10-year old male, was born at the City Hospital, Nottingham, a full term baby weighing 5 lb 4 oz.. His progress was uneventful until the age of 2 when he developed chilblain-like lesions on his hands, feet and ears which lasted the whole winter. He is a mentally normal boy with spasticity of both lower limbs. There are scars and cyanotic lesions on his toes, hands, knees, elbows and ears. He has also developed plaques of erythema around his eyes on occasions.

The article presents a case report of two patients suffering from epidermolysis with pigmentation and palmar and plantar keratoses. The 32-year-old patient had mottled pigmentary changes over the trunk and limbs with keratoses on the palms and soles. His mother and father were normal. He has one sister who is also normal. However, his only daughter is affected. This father and daughter have a condition which is hard to classify. It seems possible that it is an unusual variant of epidermolysis bullosa with keraioses and pigmentation, but the Naegeli-Franceschetti-Jadassohn syndrome has also been considered.

Three patients are reported who developed cutaneous atrophy in the upper arm following a single injection of a long-acting corticosteroid preparation into the deltoid region. [ABSTRACT FROM AUTHOR]

This article presents a case study related to herpetiform pemphigus foliaceus. Six years ago mildly pruritic lesions appeared on the faeo with extensive involvement of the trunk and limbs during the next 6 months. No past or family history of skin disease. Chronic bronchitis and dyspepsia suggestive of a dnodenal ulcer had been present for 10 years. Rheumatoid arthritis developed 18 months ago, treated with indomethaein. There were crusted erytliematous plaques 2 to 5 em in diameter disseminated over the face, scalp and trunk.

Presents a case of a 17-year old girl who had dermatitis herpetiformis. Determination of gyrate and urticarial-looking erythematous lesions on the trunk and limbs with vesicles in some sites; Contribution of dapsone to the development of lesions on her palms; Observation of urticarial-like papules on the elbows, knees and over the shoulders.

The article highlights various dermatological case studies, presented at the Irish Dermatological Society on April 30, 1966. In the spring of 1962, an erythematous rash was observed on the elbows, knees and hands of a 13-year-old boy, associated with occasional twinges in the legs. The rash had become more extensive, involving the arms, thighs, neck, post-auricular area and face. The periocular areas were puffy showing a lilac hue which on close examination revealed telangiectasia. While the patient was apyrexial and showed no evidence of joint pains or obvious muscular tenderness, the mobility of the arms, pelvic and shoulder regions appeared to be diminished and his neck posture suggested torticollis.

Thirty-three cases of pustular eruptions of the extremities were treated with triamcinolone by mouth. Twenty-four responded satisfactorily. Twelve are now off treatment completely without relapse and 12 require a daily maintenance dose of 3 mg. or less. [ABSTRACT FROM AUTHOR]

The article presents a study on congenital hemidysplasia with ichthyosiform naevus and limb defects (CHILD) syndrome, which has been referred to a rare X-linked dominant condition. Study finds unilateral inflammatory ichthyosiform naevus as the disease main features. It concludes that a mild phenotypic changes of the reported disease may present with minimal clinical signs.

The article discusses the condition of patients with severe chronic plaque psoriasis after discontinuation of efalizumab treatment. Some of them observed simultaneous enhancement on the lower extremities and proliferation of the disease on the trunk, upper extremities, and the neck. Other patients experience a gradual recurrence and worsening of their ailment.

The article discusses the condition of patients with severe chronic plaque psoriasis after discontinuation of efalizumab treatment. Some of them observed simultaneous enhancement on the lower extremities and proliferation of the disease on the trunk, upper extremities, and the neck. Other patients experience a gradual recurrence and worsening of their ailment.

The article focuses on the pimecrolimus 1% cream in the treatment of disseminated granuloma annulare. Generalized granuloma annulare (GA) is an uncommon benign cutaneous disease of unknown origin. The eruption is characterized by numerous skin-colored to erythematous papules, usually on the trunk and extremities, which demonstrate a tendency to annular grouping and a potential to involve virtually any area of the skin. Pimecrolimus, a derivative of the macrolactam ascomycin, binds to the cytosolic receptor macrophilin-1 and the resulting drug-protein complex inhibits calcineurin, resulting in the blockade of signal transduction in target cells.

Examines the treatment of recalcitrant psoriasis with daclizumab. Development of arthritic symptoms in the large joints of all extremities; Elevation of liver enzymes; Details on the inflammatory pathogenesis of psoriasis.

Angioma serpiginosum (AS) is a rare vascular naevoid disorder due to ectatic dilation of capillaries in the papillary dermis. The condition is found almost exclusively in females who have grouped erythematous punctate lesions usually on the lower limbs or buttocks, which may be unsightly. We report five patients with AS treated using a Candela SPLT1 pulsed tunable dye laser. All patients had a good to excellent response. The lesion resolved in tine patient, virtually resolved in two and is considerably improved in a further patient in whom treatment is continuing. In one patient, the angiomatous lesion improved but the patient developed hyperpigmentation at the treatment site and the treatment has been temporarily suspended. The results suggest that treatment using the pulsed dye laser is very effective for AS and, in most patients, produces an excellent cosmetic result. [ABSTRACT FROM AUTHOR]

This article presents a case report of midborderline-borderline lepromatous leprosy with reversal reaction. In June 1992, a 78-year-old man developed itchy areas on the hands, arms and feet. Red, swollen and slightly scaly lesions developed at these sites, and the skin felt warm. He was first seen in the department of dermatology of the Diaconessenhuis hospital in Voorburg, A diagnosis of borderline lepromatous leprosy was established on the basis of histopathological investigations.

Acral pseudolymphomatous angiokeratoma of children (APACHE) is a new clinical entity that is characterized by angiomatous papules on the extremities. We report a case APACHE in a 14-year-old Japanese girl with asymptomatic red and violaceous papules and nodules on the ring finger of the left hand. Histological and immunohistochemical studies of our patient indicated that APACHE is a pseudolymphoma rather than an angiokeratoma. [ABSTRACT FROM AUTHOR]

The article examines the case of a 58-year-old male patient to determine the progress of lymphomatoid papulosis to high-grade lymphoma. This patient developed lymphomatoid papulosis in 1961 on his trunks and limbs. In addition, he had an unusual ulcerated lesion over the left lower thigh. The lesion failed to heal spontaneously and was treated with low dose superficial X-rays. After some improvement, the lesion again started to grow. Further biopsy of the lesions showed a transformation to high grade B-cell lymphoma.

This article presents a medical case report related to Kaposi's sarcoma in a renal transplant recipient. The patient was a was born in Morocco and underwent a renal transplant in 1984. The immunosuppressive regimen consisted of azathioprine 100 mg/day in combination with prednisone 125 mg/day and early in 1985 purplish, nodular lesions appeared on the trunk and extremities Visceral involvement with Kaposi's sarcoma was excluded. No serological evidence for recent cytomegalovirus or HIV infection was found in laboratory tests. After the immimosuppressive therapy was discontinued the renal function deteriorated and the patient had the transplant removed. Even after discontinuation of the immunosuppressive therapy the tumours continued to grow and he had electron-beam therapy.

This article presents the case study of a patient suffering from Noonan's syndrome. This boy presented with ulerythema ophryogenes at 9 years of age. There was typical follicular hyperkeratosis of the preauricular regions and the outer aspect of the arms and legs, and alopecia of the eyebrows. This case illustrates the association between Noonan's syndrome and ulerythema ophryogenes, and it is of interest that this cutaneous disorder may be the presenting feature of Noonan's syndrome.

This article presents the case study of a patient with mycosis fungoides and parapsoriasis lichenoides. This Iranian lady has a 30-year history of a pigmented pruritic eruption on the trunk and limbs. Previous treatment has included topical steroids and PUVA. There was a widespread hyperpigmented eruption consisting of shiny, flat topped papules many of which had coalesced forming a retiform pattern, predominantly affecting the trunk and proximal extremities. This has varied from a non-specific dermal lymphocytic infiltrate without evidence of epidermotropism, to changes consistent with mycosis fungoides.

This article presents the case study of a patient suffering from porokeratosis of Mibelli in an immunosuppressed patient. The patient developed two lesions on the right upper arm in 1978. In 1971 he had been diagnosed as having chronic active hepatitis and started on prednisolone 30 mg daily, reducing to 15 mg after 3 months. A biopsy from the lateral lesion shows invagination of the epidermis out of which arises a parakeratotic column. Beneath this cornoid lamella the granular layer is absent. A perivascular infiltrate is present in the dermis. Immunosuppression is recognized to predispose to the development of porokeratosis and to cause spread of pre-existing lesions.

This article presents the case study of a patient suffering from extensive linear epidermal naevi and polyostotic fibrous dysplasia. This patient was born with a pigmented birthmark extending down the anterior midline and left arm. Rickets was diagnosed at the age of 2 and he was treated with vitamin D for 1 year. This patient with polyostotic fibrous dysplasia has the hitherto undescribed association of a linear epidermal naevus and the rarely reported association of hypophosphataemic osteomalacia. Parts of the epidermal naevus have been excised, and etretinate 25 mg daily has been commenced to reduce the symptomatic hyperkeratosis.

The article presents a case report on transient cosinophilic nodules. In January 1981, a 71 year old female patient suddenly developed skin lesions on the trunk, arms and legs with generalized pruritus. A bacterial superinfection of the skin was treated with antibiotics. Although the rash at first disappeared, it reappeared one month later. An erythernato-papular rash was present on the back, abdomen, buttocks and extremities. The bacterial infection was treated with oral flucloxacillin and local silver-suiphadiazinc ointment for two days. The rash decreased during this time and subsequently faded completely.

This article presents the case study of a person suffering from scleroedema adultorum with paraproteinaemia. For 4 years, he has noticed increasing stiffness of the skin, which started around the neck and upper trunk and has since spread to involve the face and upper arms. He is a heavily-built male Caucasian with a rather immobile distended facies. There is non-pitting oedema of the skin over the upper part of the trunk and around the neck, which appears thickened and markedly indurated. Scleroedema adultorum can be classified into two main groups. The variety originally described is a sell-limiting condition which can occur at any age and usually follows an acute infective episode. In the second group, the condition arises insidiously and may progress relentlessly over the course of many years.

This article discusses subacute cutaneous lupus crythematosus with polyneuropathy in a female aged 53. Since 1974 this patient has had a skin disorder, initially on the face but since 1977 also on the trunk and extremities. There are spontaneous remissions and exacerbations. Sunlight aggravates the disorder. The patient complains of a loss of sensitivity of both feet. The trunk, especially the back, the limbs and the face present a symmetrical erythematous slightly raised eruption consisting partly of papules, partly of annular and polycyclic lesions, which become scaly and disappear without scarring.

This article discusses traumatic swelling in Weber-Christain disease, which is due to multiple protease inhibitor deficiencies. For many years the patient had complained of painful lumps on the arms and legs, later spreading to the mammae, gluteal area and back, which disappeared, sometimes discharging fluid, leaving depressed scars. Apart from these nodules the patient was found to develop enormous swellings after relatively minor trauma. Biochemical examination of the clotting, fibrinolysis, kallikrein and complement systems of this particular patient showed, besides a slightly depressed C3 level, multiple plasma protease-inhibitor deficiencies.

The article presents the case report of a female suffering from incontinentia pigmenti achromians (hypomelanosis of Ito). Hypopigmented whorls and streaks were noticed on her trunk and limbs at 3 months when the rest of her skin had sun-tanned normally. The pigmentary changes are now less obvious but the hair on the vertex is still abnormal and slow growing. This girl shows the cutaneous features of incontinentia pigmenti achromians.

A case of the epidermal naevus syndrome is presented. Huge enlargement of both lower limbs was the presenting symptom together with an extensive naevus unius lateris on the trunk. [ABSTRACT FROM AUTHOR]

The article presents a case report of a patient suffering from eruptive juvenile melanomata. The patient was a 49 year old female and her eruption started in 1948 on the extensor aspects of her upper arms and on her buttocks. New lesions have continued to appear over the years in the areas initially affected and subsequently over most of the body, especially on the thighs and anterior abdominal wall. Palms, soles and mucous membranes have been spared. New lesions have appeared much less frequently in the past 4 years. Individual elements began as lichenoid papules, enlarging to form scaly orange colored nodules averaging about 8 mm in diameter and 3 mm in depth, many with a pale halo.

The article discusses a case of dermatitis. The patient has recurrent atopic dermatitis mainly on arms and face from the age of one year. This disease attacks each year in May for few weeks, severe enough to warrant about 20 hospital admissions. Attacks are associated with severe hey fever and start with urticaria. A well as having an atopic dermatitis, aggravated each year by an inhalant allergy to grass pollens, the patient also demonstrates a double sensitivity to lichens comparable to that found in American rag-weed sensitivity.

The article presents a case study of a 63-year-old man suffering from Systemic Lupus Erythematosus. She was seen elsewhere in 1962 with epistaxis and purpuric patches on her limbs, splenomegaly and a platelet count of 45,000 per cubic milimeter. A diagnosis of idiopathic thrombocytopenic purpura was made and treatment instituted with full doses of prednisolone for 6 months was given without benefit. Splenectomy was performed and the platelet count rose to 300,000 per cubic milimeter in 48 hours.