Biomedical subjects

Alexander Enk

Publications and source records attributed to Alexander Enk.

5 recordsLinked to original sources

PubMed2006

Gnathostomiasis: import from Laos.

Gnathostomiasis is a nematode infestation endemic in Southeast Asia, which can involve multiple organs including the liver, eyes, gastrointestinal tract and CNS. The most common manifestation is recurrent migratory subcutaneous swellings which can appear anywhere on the body and are accompanied by pruritus and systemic symptoms such as low-grade fever, loss of appetite and nausea. The diagnosis is based on the clinical picture, history of travel, peripheral blood eosinophilia and the determination of agent-specific antibody levels. The standard treatment is albendazole. We present a 37-year-old Laotian woman, who had lived in Germany for 17 years, but developed recurrent swelling of the cheek following a visit to Laos. Because of the typical clinical findings, the history of a visit to Laos, and the presence of specific anti-Gnathostoma antibodies on Western blot, the diagnosis of cutaneous gnathostomiasis was made.

Adult↗

PubMed2006

[Ehlers-Danlos syndrome--20 years experience with diagnosis and classification at the university skin clinic of Heidelberg].

BACKGROUND: The Ehlers-Danlos syndrome encompasses a group of hereditary disorders of the connective tissue, characterized by hyperextensible skin, joint hypermobility; and varying degrees of vessel and tissue fragility. The main forms are classical, hypermobile, vascular, kyphoscoliotic A/B, arthrochalasis A/B and dermatosparaxis types. PATIENTS AND METHODS: We report our experience in diagnosis and classification of Ehlers-Danlos-syndrome, especially with the combination of clinical and morphological criteria, at the Department of Dermatology of the University of Heidelberg with more than 600 patients between 1984 and 2004. RESULTS: We classified those types of EDS which are characterized by regular and characteristic ultrastructural changes in the dermal components, primarily collagen, including the classical, hypermobile and vascular types as well as the less-common arthrochalasis and dermatosparaxis types. The combination of clinical and morphologic features facilitates the selection of candidate genes for molecular genetic investigation. CONCLUSIONS: Besides the skin, skeleton and vessels, many other organ systems such as eyes and intestine, can be affected in Ehlers-Danlos syndrome. Accordingly, interdisciplinary cooperation (pediatrics, surgery, orthopedics, rheumatology, neurology, genetics) is necessary. As the connective tissue of the skin is accessible for biopsy and diagnostic investigation, dermatologists should be trained in the diagnostic approach and classification of this syndrome.

Academic Medical Centers↗

PubMed2004

A phase I vaccination study with tyrosinase in patients with stage II melanoma using recombinant modified vaccinia virus Ankara (MVA-hTyr).

A significant percentage of patients with stage II melanomas suffer a relapse after surgery and therefore need the development of adjuvant therapies. In the study reported here, safety and immunological response were analyzed after vaccination in an adjuvant setting with recombinant modified vaccinia virus Ankara carrying the cDNA for human tyrosinase (MVA-hTyr). A total of 20 patients were included and vaccinated three times at 4-week intervals with 5x10(8) IU of MVA-hTyr each time. The responses to the viral vector, to known HLA class I-restricted tyrosinase peptides, and to dendritic cells transfected with tyrosinase mRNA, were investigated by ELISpot assay on both ex vivo T cells and on T cells stimulated in vitro prior to testing. The delivery of MVA-hTyr was safe and did not cause any side effects above grade 2. A strong response to the viral vector was achieved, indicated by an increase in the frequency of MVA-specific CD4+ and CD8+ T cells and an increase in virus-specific antibody titers. However, no tyrosinase-specific T-cell or antibody response was observed with MVA-hTyr in any of the vaccinated patients. Although MVA-hTyr provides a safe and effective antigen-delivery system, it does not elicit a measurable immune response to its transgene product in patients with stage II melanoma after repeated combined intradermal and subcutaneous vaccination. We presume that modification of the antigen and/or prime-boost vaccination applying different approaches to antigen delivery may be required to induce an effective tyrosinase-specific immune response.

Adult↗

PubMed2004

[Treatment of pemphigus vulgaris with high-dose intravenous immunoglobulins in a patient with steroid-induced osteonecrosis of the femoral head].

High-dose immunoglobulins (IVIG) are important agents in the treatment of numerous autoimmune disorders. In the field of dermatology, increasing numbers of patients with bullous autoimmune disorders and mixed connective tissue diseases have been treated. We successfully treated a patient with pemphigus vulgaris with IVIG, after he had developed osteonecrosis of his right femoral head while on azathioprine and corticosteroids. After reduction of oral corticosteroids, his disease flared dramatically. The addition of a high dose immunosuppressive regimen including azathioprine and dapsone failed to help. Thus high dose IVIG (2 mg/kg, 4 weeks interval) therapy was initiated and induced complete healing of the skin lesions. The clinical improvement and the titer of the relevant autoantibodies against desmoglein 3 and desmoglein 1 showed correlation.

Adult↗

PubMed2003

[The use of high dose intravenous immunoglobulins in dermatology].

High dose intravenous immunoglobulins (IVIG) are important agents in the treatment of numerous diseases in rheumatology and dermatology. Because the diseases treated with IVIG are rare, their use is mostly not based on controlled randomized trials. Since the high costs of therapy often prohibit the use of IVIG as first line therapy and as there are no guidelines on the use of IVIG in dermatologic diseases, a consensus conference was held in Wiesbaden, Germany, to address these issues. This manuscript documents the expert consensus on the use of IVIG in dermatology and reflects current clinical practice. It should be a guideline for the practitioner for the use of IVIG in dermatologic diseases.

Dermatology↗