Lymphography was performed in 28 patients with mycosis fungoides. In 22 of the patients, the investigation took place prior to 2 months after the diagnosis was established, and in 7 of these lymphography was made before the histological verification of mycosis fungoides was possible. Five patients with widespread, persistent and severe atopic dermatitis served as controls. Eighteen patients with mycosis fungoides (64%) had abnormal lymphograms, while all 5 controls had normal lymphograms. Abnormal findings were diagnosed in 12 of 22 patients at the earliest time possible during the course of their disease and even found in 5 of 7 patients who only had premycotic lesions at the time of investigation. These results may have some bearing on therapy, suggesting that systemic treatment could possibly be introduced at a far earlier disease stage than is the custom at present.

Oral retinoids seem to have been of great benefit in a non-randomized study on advanced mycosis fungoides using two different chemotherapy regimens, one with retinoid, the other without. Both groups also received a 3-drug chemotherapy with bleomycin, cyclophosphamide and prednisone. Complete remission including all signs of lymph-node involvement was found in 8 of 10 patients of the retinoid treated group, while none went into complete remission in the control group. All in the control group died between 3 and 12 months after therapy, whereas all but one in the retinoid treated group are alive. Other treatment differences between the groups were related to the use of transfer factor, topical treatment, and steroid administration. These differences make a final evaluation of the use of retinoids in mycosis fungoides difficult at the present stage. Further studies are needed.

Sixteen patients with mycosis fungoides (MF) were given either active transfer factor (TF) or heat-inactivated TF as additional therapy to topical nitrogen mustard or PUVA. The TF was prepared from non-selected healthy blood donors. The clinical evaluation after 2 years of therapy showed that among 8 patients treated with active TF, none went into complete remission of their disease 4 patients had partial remission, one was unchanged, 2 progressed, and one died of active MF. In the placebo-treated group, 5 patients achieved complete remission and 2 partial remission. One patient died early in the trial due to cardiac disease. Immunological studies during the first year of therapy revealed cutaneous anergy towards tuberculin in most patients. This anergy did not change during TF therapy and differed from normal lymphocyte reactivity in vitro after tuberculin stimulation. At the start of treatment the patients had diminished levels of T lymphocytes in peripheral blood. A temporary increase was observed in the total number of T lymphocytes in patients after one month of treatment with active TF. After one year the T lymphopenia had disappeared in both groups. The mitogen reactivity of lymphocytes was found to be normal (PHA, PWM) or somewhat reduced (Con A). It is concluded that under the conditions employed in this trial, TF was not able to prevent progression of early mycosis fungoides, when viewed over a period of 2 years.

13 patients with clinically and histologically verified mycosis fungoides were treated with transfer factor as additional therapy to the hitherto conventional treatment after this had failed. After approximately 3 years, complete remission was present in 3 patients, 4 patients were significantly improved and registered as being in partial remission, while the condition was registered as no change in 3 patients. 1 patient was found worse, 1 patient had died after discontinuation of therapy and 1 patient was out of the study. In this case treatment was withdrawn because of the development of contact urticaria to nitrogen mustard, her basic therapy. The number of T lymphocytes, which was low prior to treatment, increased to normal values during the therapeutic period. During the first year a decrease in serum IgE was noted. The results of the clinical evaluation seem to indicate that transfer factor may be of value as an additional therapeutic agent in mycosis fungoides. Controlled investigations are needed and are in progress.

A report is given of the successful treatment with transfer factor as an additional therapeutic agent of a patient in the tumour stage of mycosis fungoides who had not responded to conventional treatment with nitrogen mustard, methotrexate, or grenz rays alone. Besides twelve injections of transfer factor, the patient received X-irradiation, 1 400 r (50 kV 1 mm Al) in all, to three tumours. The combined treatment induced sustained remissions. When that patient died from a coronary infarct 5 years after treatment began, autopsy showed no evidence of mycosis fungoides at all.

'Brodie, J, J7ournal of Hygiene, 1977, 79, 161 and 181. ' Ministry of Housing and Local Government, Safeguards to be Adopted in the Operation andManagement of Waterworks. London, HMSO, 1967. 3 Public Health Laboratory Service, Journal of Hygiene. In press. ' Department of Health and Social Security. Health Service Catering. II: Hygiene in Catering and Food Service Areas. London, HMSO, 1974. Rahman, A F M S, and Cowan, M E, British Medical Journal, 1974, 11, 121.

Ejaculates were studied from ten men with severa psoriasis treated with topical corticosteroids and from ten similar patients who had received methotrexate therapy from 1 to 9 years. It was not possible to demonstrate any unfavorable effect on the semen quality during the methotrexate therapy. The semen analysis was more frequently found normal (p = 0.04) in the methotrexate treated group, and no specific abnormality was found in spermatozoa of methotrexate-treated patients. Methotrexate therapy to male psoriatics seems safe and in agreement with this no congenital abnormalities have been reported. A remarkable number of the ejaculates had reduced sperm qualities, and it is proposed that this might be due to psoriatic lesions in the genital tract.

A 36-year-old woman and a 16-year-old boy, both suffering from mycosis fungoides, developed urticaria and an anaphylactoid reaction after topical whole body application of nitrogen mustard. Prick tests with nitrogen mustard solution produced a weal and flare response. Both patients had previously been treated intermittently with total body application of nitrogen mustard for 2 1/2 years and 1 year respectively without complications.

Eight accidental kidney biopsies in psoriatics were obtained together with 429 liver biopsies. None of the biopsies showed signs of renal damage. All patients had severe psoriasis, six had been treated with methotrexate for 1-2-6 years, receiving total dosages from 660 to 1757 g.

Two-hundred and eighty-six liver biopsies were performed in 139 psoriatics on treatment or considered for treatment with methotrexate. In 56 psoriatics included in this study both pre- and post-methotrexate biopsies were performed, the average methotrexate dose being 936 mg. None of the data showed statistically significant differences between pre- and post-methotrexate biopsies, with the exception of an increase in fattly infiltration, found when comparing all pre-methotrexate biopsies with the total number of latest post-methotrexate samples. As expected, alcohol seemed to be significantly associated with liver fibrosis in pre-methotrexate biopsies. An patients, although potassium arsenite alone has not been proved to be the cause of liver damage among psoriatics included in this study. While only 1 of 22 psoriatics with a total normal biopsy had been on arsenite, 6 of 18 of the same group of psoriatics who had fibrosis had been on this drug earlier. Although no statistically significant differences related to fibrosis and cirrhosis could that in three cases liver cirrhosis did appear in a biopsy from a methotrexate-treated psoriatic who had signs of fibrosis of cirrhosis in a pre-methotrexate biopsy. This incidence is low in relation to the total number of patients treated. The relatively low incidence of cirrhosis found in the present study, as in earlier studies by our group is believed to be due to the use of an intermittent dosage schedule. The study showed that early fibrosis and cirrhosis seem to appear, with very minor abnormalities in laboratory results. This finding indicates the necessity of performing liver biopsies in the control of psoriatics on long-term methotrexate therapy. The difference between biopsies from psoriatics and liver biopsies from control patients may indicate that severity of disease may be a complicating factor in the pathogenesis of the liver damage.

To the Editor.— Within recent years, transfer factor (TF) has been given to a number of patients with immunodeficiency diseases. Lately, TF has also been used to intensify cell-mediated immunity in patients with relative immunological defects.1-3Although mycosis fungoides seems to be a T cell lymphoma, a number of patients with this disease show a reduced ability to develop cellular immunity.4We therefore found it reasonable to try TF in addition to other therapeutic measures in a patient who did not respond to conventional treatment with mechlorethamine hydrochloride, methotrexate, or grenz rays alone. Report of a Case.— A 64-year-old man had a 1½-year history of general itching and appearance of scaly erythematous plaques and tumors located at the elbows (Fig 1) and the gluteal area. Within two months, he developed heavy keratotic infiltrations of the palms (Fig 2) and soles with many fissures (Fig 3), together with a

The role of T- and B-lymphocytes and serum IgE was studied in 22 patients with mycosis fungoides. The distribution of B-cells in peripheral blood was normal, while the mean percentage of T-cells was significantly lower than in 14 healthy controls. Four patients with mycosis fungoides in stages I to IV had a highly elevated serum IgE, while serum IgE in remaining patients was slightly elevated, normal, or subnormal. The mean serum IgE level was not significantly elevated. Our results tend to show that a reduced ability to react with cellular immunity may be an important factor in mycosis fungoides. This may have therapeutic aspects.

An investigation of drinking habits of psoriatic patients and of a control group of healthy persons is described. No difference could be detected between the alcohol consumption of these groups.