CD30+ Lymphoproliferative Disorder/Lymphomatoid Papulosis - A Regression Caused by Mistletoe Therapy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4779-4779
Author(s):  
Georg Seifert ◽  
Christoph Tautz ◽  
Karl Seeger ◽  
Guenter Henze ◽  
Alfred Laengler
Keyword(s):  
Clinical Signs ◽  
Immunohistochemical Analysis ◽  
Skin Lesions ◽  
High Risk Group ◽  
The Body ◽  
Topical Steroids ◽  
Malignant Lymphomas ◽  
Lymphomatoid Papulosis ◽  
Systemic Involvement ◽  
Increased Risk

Abstract Lymphomatoid papulosis (LyP) is a CD30+ cutaneous lymphoma according to the WHO classifications and regarded as a condition of uncertain malignant potential. The incidence of LyP in children is relatively low compared to that in adults. It is correlated with malignant lymphomas in 5–20% of adult LyP-patients. In children, an increased risk for the development of a malignant lymphoma is observed. The clinical course is often chronic. Most common treatment for LyP is topical steroids, antibiotics, phototherapy and low-dose methotrexate. Prognosis is excellent with a survival of 100% even for patients with malignant lymphomas. Case-report: An 8-years old boy suffered from reddish nodules (maximum 7 cm in diameter) on his right forearm and his left leg. Immunohistochemical analysis identified a CD30+large-T-cell-type-NHL of the skin. Topic steroids were effective but six months later he showed axillar lymph-node swelling. Immunohistochemically it was classified as anaplastic large cell T-type-lymphoma (ALCL) without signs of systemic involvement. Combination chemotherapy according to the European ALCL-trial (high-risk-group) was given for six months. All nodules (cutaneous and lympoid/axilla) resolved within a few weeks. Two months after cessation of chemotherapy a new skin-nodule on the left forearm appeared. The immunohistochemical diagnosis was now LyP. No specific therapy was given. In the following two months he developed two further solid and painful skin-lesions. In this situation we decided to start a therapeutic approach with subcutaneous mistleote (MT), which was injected close to one of these lesions. The skin-nodules decreased after the first dose and MT injections into all nodules were continued. Within the following two weeks the skin-lesions resolved completely and subcutaneous MT therapy was continued. Two months later, he developed two new nodules responding within a few days to increased dose of MT. While continuation therapy with MT the boy was without clinical signs both of the LvP and ALCL for nearly two years. Subsequently MT therapy was terminated. Three weeks after cessation the cutaneus LyP generally reactivated all over the body with typical nodules (maximum 1 cm in diameter). Subcutaneus MT therapy was restarted and the cutnaneus LyP regressed within 2 weeks completely without additional therapy.

scholarly journals Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses

2016 ◽  
Vol 17 (6) ◽  
pp. 425-433 ◽  
Author(s):  
Ghada Asmar ◽  
Dominique Cochelard ◽  
Jacques Mokhbat ◽  
Mohamed Lemdani ◽  
Ahmed Haddadi
Keyword(s):  
Antibiotic Prescription ◽  
Medical Condition ◽  
Local Treatment ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Medical Community ◽  
Chi Square ◽  
Systemic Involvement ◽  
Increased Risk ◽  
General Dentists

ABSTRACT Introduction General dentists issue approximately 10% of antibiotic prescriptions across the global medical community consummation. The use of antibiotics for the management of dentoalveolar infections should be considered only in the presence of an increased risk of a systemic involvement or to prevent metastatic infections. This study aimed to investigate the prophylactic and therapeutic antibiotic prescription patterns of Lebanese dentists for the management of dentoalveolar abscesses. The aim was to evaluate the influence of the patients’ medical condition and clinical signs data on the patterns of antibiotics prescription. Materials and methods Only patients with a dentoalveolar abscess were included in the study. Age, medical history, reason for consultation, clinical signs and symptoms, diagnosis, type of local treatment, and type of antibiotherapy were collected for each patient attending dental clinics in Beirut. The data were analyzed with chi-square test and multivariate regression. Results Out of the 563 initial patients, 127 were selected for the study and received a local treatment. The patient's medical condition and age did not affect the decision to prescribe antibiotics 36.2% patients with pain and 11.8% patients with swelling were prescribed antibiotics. Pain and swelling contributed to a higher level of antibiotic prescription compared to other signs and symptoms. Antibiotics were prescribed inappropriately to 51.76 and 38.10% among patients with an acute or chronic dentoalveolar abscess respectively. The main prescribed antibiotic was amoxicillin. Conclusion This study showed that dentists often did not follow the current prophylactic and therapeutic antibiotic prescription guidelines. Clinical significance Antibiotics prescriptions in dentistry will be more pertinent, leading to a decrease in inadequacy of prescriptions, microbial resistance, and the development of multiresistant germs against antibiotics. How to cite this article Asmar G, Cochelard D, Mokhbat J, Lemdani M, Haddadi A, Ayoub F. Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses. J Contemp Dent Pract 2016;17(6):425-433.

scholarly journals P38 A rare case of rheumatoid arthritis with perforating collagenosis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Subhasish Deb ◽  
Srinivasan Srirangan
Keyword(s):  
Rheumatoid Arthritis ◽  
Skin Biopsy ◽  
Rare Case ◽  
Skin Lesions ◽  
The Body ◽  
Topical Steroids ◽  
Rheumatoid Vasculitis ◽  
Cutaneous Manifestations ◽  
Granulomatous Dermatitis ◽  
Disease Modifying

Abstract Background Rheumatoid arthritis has multiple cutaneous manifestations with rheumatoid nodule being the commonest one. A maculopapular rash in setting of rheumatoid arthritis has a varied list of differentials including rheumatoid vasculitis, pyoderma gangrenosum, rheumatoid neutrophilic dermatosis, interstitial granulomatous dermatitis and palisaded neutrophilic granulomatous dermatitis. We present a rare case of patient with rheumatoid arthritis with perforating collagenosis. Methods A case report is presented in the results section. Results A 64 year old lady known to have seropositive rheumatoid arthritis for the past 6 years with poor compliance to treatment presented with maculopapular lesions on both her legs and abdomen. The lesions were itchy in nature and later became ulcerative. The lesions spread to various parts of the body over the next 4 weeks and patient was seen by a dermatologist who initially prescribed topical therapy and the patient came off her disease modifying anti rheumatic agents. She underwent a skin biopsy as initial investigations were otherwise unremarkable. Skin biopsy revealed a diagnosis of perforating collagenosis. She was given topical steroids and counselled regarding the need to take her disease modifying anti rheumatic drugs regularly. There was 95% resolution of skin lesions within 6 months. Conclusion Perforating collagenosis is a skin disorder characterised by transepithelial expulsion of dermal tissue which presents as a papulonodular rash with central keratin plugs. It is usually associated with diabetes mellitus and chronic kidney disease but rarely been reported in association with rheumatoid arthritis. Literature review revealed that there have been only 2 cases reported previously. The first case has been described in 2010 in a man from Singapore on treatment for RA for 2 years. Second case has been described by Ikeda et al in 2019 in a case of rheumatoid vasculitis. Clinically it presents as umbilicated, hyperkeratotic papules with a central white keratotic crust. Koebnerization may be seen and itching of surrounding regions may lead to papules to coalesce and form plaques. A biopsy will reveal features similar to those seen in the primary disease where perforating collagenosis shows cup shaped invagination of the epidermis filled with a plug consisting of keratin and cellular debris. There have been no trials and treatment is based on case reports. We believe that better compliance to her disease modifying anti rheumatic agent therapy, leading to improved treatment of the systemic cause had a significant role in resolving her skin lesions. Disclosures S. Deb None. S. Srirangan None.

scholarly journals Hormone-Related Cancer and Autoimmune Diseases: A Complex Interplay to be Discovered

2022 ◽  
Vol 12 ◽  
Author(s):  
A Losada-García ◽  
SA Cortés-Ramírez ◽  
M Cruz-Burgos ◽  
M Morales-Pacheco ◽  
Carlos D Cruz-Hernández ◽  
...  
Keyword(s):  
Immune System ◽  
Autoimmune Diseases ◽  
Molecular Mechanisms ◽  
Continuous Process ◽  
Clinical Signs ◽  
The Body ◽  
Future Research ◽  
Adaptive Immune ◽  
Increased Risk ◽  
Risk Of Cancer

Neoplasic transformation is a continuous process that occurs in the body. Even before clinical signs, the immune system is capable of recognizing these aberrant cells and reacting to suppress them. However, transformed cells acquire the ability to evade innate and adaptive immune defenses through the secretion of molecules that inhibit immune effector functions, resulting in tumor progression. Hormones have the ability to modulate the immune system and are involved in the pathogenesis of autoimmune diseases, and cancer. Hormones can control both the innate and adaptive immune systems in men and women. For example androgens reduce immunity through modulating the production of pro-inflammatory and anti-inflammatory mediators. Women are more prone than men to suffer from autoimmune diseases such as systemic lupus erythematosus, psoriasis and others. This is linked to female hormones modulating the immune system. Patients with autoimmune diseases consistently have an increased risk of cancer, either as a result of underlying immune system dysregulation or as a side effect of pharmaceutical treatments. Epidemiological data on cancer incidence emphasize the link between the immune system and cancer. We outline and illustrate the occurrence of hormone-related cancer and its relationship to the immune system or autoimmune diseases in this review. It is obvious that some observations are contentious and require explanation of molecular mechanisms and validation. As a result, future research should clarify the molecular pathways involved, including any causal relationships, in order to eventually allocate information that will aid in the treatment of hormone-sensitive cancer and autoimmune illness.

scholarly journals Diffuse Cutaneous Mastocytosis in a Child - a Case Report

2017 ◽  
Vol 9 (3) ◽  
pp. 124-128
Author(s):  
Svetlana Popadić ◽  
Mirjana Gajić-Veljić ◽  
Biljana Marenović ◽  
Miloš Nikolić
Keyword(s):  
Case Report ◽  
Systemic Mastocytosis ◽  
Pediatric Population ◽  
Skin Lesions ◽  
Clinical Findings ◽  
Topical Steroids ◽  
Systemic Involvement ◽  
Clonal Proliferation ◽  
Cutaneous Mastocytosis

Abstract Mastocytosis refers to a group of diseases characterized by a clonal proliferation and accumulation of mast cells in one or more tissues/organs with different clinical presentations. In children, limited cutaneous forms of mastocytosis are rather frequent, while systemic mastocytosis is rare. The diagnosis of cutaneous mastocytosis is based on clinical findings and histopathology. We present a patient who developed skin lesions at the age of 18 months. Clinical findings, confirmed by histopathology, were consistent with diffuse cutaneous mastocytosis. The follow-up period was 7 years. The treatment included oral antihistamines in combination with mast cell stabilizers, mild topical steroids and avoidance of friction. During the follow-up period, there were no signs of systemic involvement, and the quality of life was preserved, despite the large surface of affected skin. This case report should increase the awareness and knowledge of clinicians about this rare form of cutaneous mastocytosis in the pediatric population.

scholarly journals Canine atopic dermatitis in the Middle East: clinical signs, signalment and common allergens

2012 ◽  
Vol 57 (No. 8) ◽  
pp. 410-419 ◽  
Author(s):  
G. Zur ◽  
I. Skorinsky ◽  
T. Bdolah-Abram
Keyword(s):  
Atopic Dermatitis ◽  
Middle Eastern ◽  
Disease Onset ◽  
Clinical Signs ◽  
Onset Time ◽  
Skin Lesions ◽  
The Body ◽  
German Shepherd ◽  
Canine Atopic Dermatitis ◽  
German Shepherd Dog

  The aim of the study was to examine for the first time the various aspects of canine atopic dermatitis (CAD) presenting in a Middle Eastern country. Medical records of 164 dogs diagnosed with CAD were evaluated. Associations between signalment, lifestyle, clinical signs and allergens were evaluated statistically. Labrador Retriever, German Shepherd dog, Boxer, French Bulldog, Golden Retriever and Shar-Pei breeds were presented more frequently than the regular hospital population (P < 0.0001), and had an earlier disease onset time (P < 0.01). In 22 dogs (13%) signs of CAD were noticed at less than six months of age. Most dogs (75%) lived indoors. Most dogs (83%) had lesions on the ventral part of the body and 68% had foot lesions. After excluding flea allergy dermatitis by implementing strict flea control, 60% of the dogs presented with dorsal distribution of skin lesions. Dogs with ventral lesions were younger when clinical signs first appeared (P < 0.05). Most of the dogs were allergic to dust and/or dust mites (75.6%), with weeds and trees as the next most common allergens. CAD is similar worldwide, but geographic differences may be attributable to genetic pools and allergen loading. This study also shows that early onset of clinical signs, especially in breeds predisposed to CAD and with a dorsal distribution of skin lesions, should not rule out the diagnosis of CAD.  

scholarly journals Vascular Obliteration Due To Endothelial And Myointimal Growth In COVID-19

2020 ◽  
Author(s):  
Jara Valtueña ◽  
Gerardo Martínez-García ◽  
Daniel Ruiz-Sánchez ◽  
María Garayar-Cantero ◽  
Carlos Dueñas ◽  
...  
Keyword(s):  
Skin Lesions ◽  
The Body ◽  
Therapeutic Interventions ◽  
Lung Mechanics ◽  
Surrounding Tissue ◽  
Reaction Pattern ◽  
Living Tissue ◽  
Vascular Lumen ◽  
Increased Risk ◽  
Histological Data

Abstract Background: Severe coronavirus disease 2019 (Covid-19) is a systemic multi-organ viral invasion. Previous studies found that many patients had a procoagulant state and/or severe hypoxemia with relatively well-preserved lung mechanics. Mechanisms underlying the vascular and its surrounding tissue are not well known yet. Histological data in Covid-19 tissues´ patients are still limited and mainly focused on post-mortem analysis. Since SARS-CoV-2 largely affects cutaneous tissue, we aim to examine in depth skin lesions related to Covid-19 in order to understand better how the disease might affect living tissue.Methods: Five skin lesions from Covid-19 adult patients were selected for histological tissue examination. Vast amount of data of immunohistochemistry (IHC) and direct immunofluorescent (DIF) were part of the assessment. Results: A common strong vasculopathic reaction pattern based on prominent vascular endothelial and myointimal cellgrowth was identified. Endothelial cell distortion generated vascular lumen obliteration and a strike erythrocyte and serum extravasation. Extensive significant vascular C4d and C3 deposition throughout vascular cell wall was also identified. A regenerative epidermal hyperplasia with tissue structure preservation was found. Conclusions: Covid-19 could comprise an obliterative micro-angiopathy consisting on endothelial and myointimal intensive growth with complement activation. This mechanism, together with increased vascular permeability identified, could contribute to obliterative vascular lumen and hemorrhage in Covid-19. Activation of the complement and angiogenic pathways could have an important role in inducing and maintaining this vasculopathic reaction pattern. Thus, anticoagulation by itself could not completely reverse vascular lumen obliteration, with consequent hemorrhagic increased risk associated. Skin is the largest organ in the body, the most accessible one and can mirror other organs of the body. Findings of this study could contribute to a better understanding of physio-pathological mechanisms underlying SARS-CoV-2 infection on living tissue and could help further studies find potential targets for specific therapeutic interventions in Covid-19 severe patients.

scholarly journals Sheeppox in Evros. A 7-year (1994 - 2000) retrospective study

2018 ◽  
Vol 54 (2) ◽  
pp. 172 ◽  
Author(s):  
C. DADOUSIS (Κ. ΔΑΔΟΥΣΗΣ)
Keyword(s):  
Clinical Signs ◽  
Foot And Mouth Disease ◽  
Skin Lesions ◽  
The Body ◽  
Control Measures ◽  
Outbreak Period ◽  
Evros River ◽  
Risk Areas ◽  
Mode Of Transmission ◽  
Cumulative Experience

Sheeppox is a highly transmissible disease that caused the development of serious economical losses to the livestock of Evros County. From 1994 to 2000, following an absence of appearance in 1999, sheeppox has constantly occurred on a year basis. During the last sheepox epidemic in 1998, eradication measures have been implemented to control the disease. Stamping out of the animals from affected flocks and flock vaccination for the risk areas have been performed. Since 1994 and after, elimination procedures have been applied on affected and suspected flocks. In particular, (83), (677), (21.020), (8.838), (1512) and (507)animals were eliminated (stamping out) in 1994, 1995, 1996, 1997,1998 and 2000 respectively. The mode of transmission of pox disease must be differentiated from the Foot and Mouth disease and its expected incidence during an outbreak period. The compulsory by legislation 21-day isolation of pox-infected flocks shall be considered insufficient due to the virus resistance. Pox nodules, primarily seen on the parts of the body not covered by wool and skin lesions on the tail, are the most typical clinical signs. There is evidence to believe that pox virus was introduced into Greece from Turkey, because the disease is endemic in Turkey and our primary incursions have been detected close to Evros River, the borderline between the two countries. Area of epidemiological importance, where new outbreaks have yearly occurred (no reports in 1994), is Orestiada landscape, including Petrades village. The first confirmed cases of sheeppox, which were reported in fall 1994-95, 2000 (October- November) and summer 1996-98 (July). No cases were reported in winter. In this study, the sheep pox statistics, epizootiology, symptomatology, control measures and photo-images of the disease were reviewed based on cumulative experience.

scholarly journals Vascular Obliteration Due To Endothelial And Myointimal Growth In COVID-19

2020 ◽  
Author(s):  
Jara Valtueña ◽  
Gerardo Martínez-García ◽  
Daniel Ruiz-Sánchez ◽  
María Garayar-Cantero ◽  
Carlos Dueñas ◽  
...  
Keyword(s):  
Skin Lesions ◽  
The Body ◽  
Therapeutic Interventions ◽  
Lung Mechanics ◽  
Surrounding Tissue ◽  
Reaction Pattern ◽  
Vascular Lumen ◽  
Increased Risk ◽  
Cutaneous Tissue ◽  
Histological Data

Abstract Background: Severe coronavirus disease 2019 (Covid-19) is a systemic multi-organ viral invasion. Previous studies found that many patients had a procoagulant state and/or severe hypoxemia with relatively well-preserved lung mechanics. Mechanisms underlying the vascular and its surrounding tissue are not well known yet. Histological data in Covid-19 tissues´ patients are still limited and mainly focused on post-mortem analysis. Since SARS-CoV-2 largely affects cutaneous tissue, we aim to assess the pathophysiologic mechanisms in depth in living skin tissue related to Covid-19.Methods: Five skin lesions from caucasian Covid-19 adult patients were selected for cutaneous tissue histological examination including immunohistochemistry (IHC) and direct immunofluorescent (DIF) vast amount of data. Results: A common strong vasculopathic reaction pattern based on prominent vascular endothelial and myointimal cellgrowth was identified. Endothelial cell distortion generated vascular lumen obliteration and a strike erythrocyte and serum extravasation. Extensive significant vascular C4d and C3 deposition throughout vascular cell wall was also identified. A regenerative epidermal hyperplasia with tissue structure preservation was also found. Conclusions: Covid-19 could comprise an obliterative micro-angiopathy consisting on endothelial and myointimal intensive growth with complement activation. This mechanism, together with increased vascular permeability identified, could contribute to obliterative vascular lumen and hemorrhage in Covid-19 disease. Activation of the complement and angiogenic pathways could have an important role in inducing and maintaining this vasculopathic reaction pattern. Thus, anticoagulation by itself could not completely reverse vascular lumen obliteration, with consequent hemorrhagic increased risk associated. Skin is the largest organ in the body, the most accessible one and can mirror other organs of the body. Findings of this study could contribute to a better understanding of physio-pathological mechanisms underlying Covid-19 infection on living tissue and could help further studies find potential targets for specific therapeutic interventions in Covid-19 severe patients.

STEROID RECEPTOR PHENOTYPE, EXPRESSION OF HER-2/NEU, PD-1, PD-L1 AND LYMPHOCYTIC-MACROPHAGAL INFILTRATION OF ENDOMETRIAL CARCINOMAS: COMPARISON OF MODERN MOLECULAR BIOLOGICAL TYPES OF THE DISEASE (THE ROLE OF BODY MASS INDEX)

2020 ◽  
Vol 66 (1) ◽  
pp. 71-78
Author(s):  
Lev Bershteyn ◽  
Aleksandr Ivantsov ◽  
Aglaya Ievleva ◽  
A. Venina ◽  
I. Berlev
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Tumor Tissue ◽  
Immunohistochemical Analysis ◽  
The Body ◽  
Molecular Profile ◽  
Total N ◽  
Number Of Patients ◽  
Her 2

The aim of this study was to evaluate steroid receptors’ status of tumor tissue in different molecular biological types of endometrial cancer (EC), subdivided according to the current classification, and their colonization by lymphocytic and macrophage cells, taking into account body mass index of the patients. Materials and methods: Material from treatment-naive patients with EC (total n = 229) was included; the number of sick persons varied depending on the method used. The average age of patients was close to 60 years, and about 90% of them were postmenopausal. It was possible to divide the results of the work into two main subgroups: a) depending on the molecular biological type of the tumor (determined on the basis of genetic and immunohistochemical analysis), and b) depending on the value of the body mass index (BMI). The latter approach was used in patients with EC type demonstrating a defective mismatch repair of the incorrectly paired nucleotides (MMR-D) and with a type without characteristic molecular profile signs (WCMP), but was not applied (due to the smaller number of patients) in EC types with a POLE gene mutation or with expression of the oncoprotein p53. According to the data obtained, when comparing various types of EC, the lowest values of Allred ER and PR scores were revealed for POLE-mutant and p53 types, while the “triple-negative” variant of the tumor (ER-, PR-, HER2/neu-) was most common in POLE-mutant (45.5% of cases) and WCMP (19.4%) types of EC. The p53+ type of EC is characterized by inclination to the higher expression of the macrophage marker CD68 and lymphocytic Foxp3, as well as mRNA of PD-1 and SALL4. In addition to the said above, for WCMP type of EC is peculiar, on the contrary, a decrease in the expression of lymphocytic markers CD8 (protein) and PD-L1 (mRNA). When assessing the role of BMI, its value of >30.0 (characteristic for obesity) was combined with an inclination to the increase of HER-2/neu expression in the case of MMR-D EC type and to the decrease of HER-2 /neu, FOXp3 and ER expression in WCMP type. Conclusions: The accumulated information (mainly describing here hormonal sensitivity of the tumor tissue and its lymphocytic-macrophage infiltration) additionally confirms our earlier expressed opinion that the differences between women with EC are determined by both the affiliation of the neoplasm to one or another molecular biological type (subdivided according to the contemporary classification), as well as by body mass value and (very likely) the associated hormonal and metabolic attributes.

Heritability of the Effect of Corticosteroids on Intraocular Pressure

1970 ◽  
Vol 19 (1-2) ◽  
pp. 264-267 ◽  
Author(s):  
F.H. Reuling ◽  
J.T. Schwartz
Keyword(s):  
Intraocular Pressure ◽  
Clinical Signs ◽  
Topical Steroids ◽  
Frequency Distributions ◽  
Steroid Response ◽  
Large Numbers ◽  
Wide Range ◽  
Allele Pair ◽  
High Level ◽  
Genetically Determined

In the late 1950's and early 1960's, it became evident that some glaucoma patients developed elevations of intraocular pressure, which were difficult to control, following prolonged use of systemic or ocular medications containing corticosteroids (Chandler, 1955, Alfano, 1963; Armaly, 1963). In addition, some patients without glaucoma, when treated with steroids for long periods of time, developed clinical signs of chronic simple glaucoma (McLean, 1950; François, 1954; Covell, 1958; Linner, 1959; Goldman, 1962). Fortunately, the elevation of intraocular pressure was reversible if the drug was discontinued.Over the past decade, extensive investigation of the “steroid response” has been undertaken. For this presentation, the steroid response may be considered as a gradual elevation of intraocular pressure, occurring over several weeks, in an eye being medicated with corticosteroid drops several times a day. The elevation in pressure is usually accompanied by a reduction in the facility of aqueous outflow. When relatively large numbers of subjects were tested with topical steroids, so that a wide range of responsiveness could be observed, a variation in individual sensitivity was demonstrated. Frequency distributions of intraocular pressure or change in pressure following steroids showed a skew toward the high side. On the basis of trimodal characteristics which they observed in such frequency distributions, Becker and Hahn (1964), Becker (1965) and Armaly (1965, 1966) considered the possible existence of several genetically determined subpopulations. These investigators distinguished three subpopulations on the basis of low, intermediate, and high levels of pressure response. It was hypothesized that these levels of response characterized three phenotypes, corresponding to the three possible genotypes of an allele pair, wherein one member of the pair determined a low level of response, and the other member determined a high level of response (Armaly, 1967).

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