We describe three adolescents with eruptive linear lesions of the back, abdomen, and extremities distributed along the lines of Blaschko. Clinically one of these lesions resembled an epidermal nevus in its morphology and distribution. A biopsy specimen demonstrated the typical histology of lichen planus (LP). There have been fewer than 20 reported cases of childhood linear LP. Our patients demonstrate that linear LP sometimes may closely resemble an epidermal nevus and may auger the onset of more generalized LP or more involvement along the lines of Blaschko, that is, "Blaschkoian" disease. Previous studies have referred to this variant as zosteriform. Our cases are the fourth, fifth, and sixth cases of childhood LP reported to occur along the lines of Blaschko. Based on the clinical findings in our patients and a review of the English-language literature, we believe that linear LP is usually distributed along the lines of Blaschko and should be renamed lichen planus, Blaschko subtype.

Level III, comparative series.

Twenty retrieved Scorpio posterior-stabilized implants were available for analysis. The mean implantation time was 22 months (range, 2 days-42 months). Favorable types and amounts of surface damage were seen on the tibiofemoral and backsides of these modular PE liners that had been packaged in an inert environment and then sterilized by gamma irradiation. Delamination represented only 0.1% of the total surface damage. Off-axis loading (varus malalignment) was associated with tibial component loosening but there was no evidence of peripheral damage of PE caused by edge loading. With this open-box design, hyperextension marks on the anterior aspect of the posterior-stabilized post from femoral component impingement occurred in 11 of 20 cases and was related to sagittal component positioning: excess tibial slope or increased tibial slope combined with a flexed femoral component. Unique coarse abrasions occurred in 16 of 20 cases and were the result of cement extrusion into the open box, especially with varus malalignment. These observations provide guidance for optimizing the surgical technique and the design of posterior-stabilized total knee components.

No abstract

We report here that gemfibrozil (GFZ) inhibits axenic and intracellular growth of Legionella pneumophila and of 27 strains of wild-type and multidrug-resistant Mycobacterium tuberculosis in bacteriological medium and in human and mouse macrophages, respectively. At a concentration of 0.4 mM, GFZ completely inhibited L. pneumophila fatty acid synthesis, while at 0.12 mM it promoted cytoplasmic accumulation of polyhydroxybutyrate. To assess the mechanism(s) of these effects, we cloned an L. pneumophila FabI enoyl reductase homolog that complemented for growth an Escherichia coli strain carrying a temperature-sensitive enoyl reductase and rendered the complemented E. coli strain sensitive to GFZ at the nonpermissive temperature. GFZ noncompetitively inhibited this L. pneumophila FabI homolog, as well as M. tuberculosis InhA and E. coli FabI.The advent of AIDS and the emergence of many multidrugresistant bacterial species have led to renewed efforts to find new antibiotics. The most commonly used antibiotics act by blocking bacterium-specific DNA, RNA, or protein synthesis. Mycobacterium tuberculosis is a major exception to this generalization. While streptomycin, an inhibitor of bacterial protein synthesis, was the first antibiotic to be used successfully to treat M. tuberculosis, isoniazid (INH), an inhibitor of mycobacterial lipid synthesis, is presently the drug most commonly used to treat infections with this organism (2, 43). The differential sensitivity to INH of M. tuberculosis versus mammalian cells reflects the fact that most bacterial fatty acid synthases (type II synthases) are comprised of discrete, separable enzymes encoded by separate genes, while mammalian fatty acid synthases (type I) are dimeric proteins in which a single polypeptide catalyzes the seven enzymatic activities of fatty acid synthesis (21, 52).In previous studies (45), we reported that gemfibrozil (GFZ), a commonly prescribed and well-tolerated hypolipidemic drug, inhibits the export of various organic anions, including penicillin and fluoroquinolones, from murine macrophages, thereby elevating the intracellular concentration of these antibiotics and enhancing their capacity to block intracellular growth of Listeria monocytogenes. In exploring this system, we discovered that while GFZ has no effect on axenic or intracellular growth of Listeria monocytogenes, it inhibits axenic growth of all Legionella pneumophila strains tested and of 5 wild-type and 22 multidrug-resistant strains of M. tuberculosis and inhibits intracellular growth of L. pneumophila Philadelphia-1 and M. tuberculosis H37RV in human and mouse macrophages, respectively.Both M. tuberculosis and L. pneumophila are facultative intracellular pathogens that enter host macrophages by phagocytosis (25, 26), grow in nonlysosomal membrane-bound cytoplasmic vacuoles (24), have special nutrient requirements (38, 54, 55), and produce a relatively unique spectrum of membrane lipids (7, 57). However, M. tuberculosis is a slow-growing and dangerous organism with which to work. In cont...