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Biomedical subjects

D Nashan

Publications and source records attributed to D Nashan.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Cutaneous myiasis--a vacation souvenir].

Cutaneous myiasis is a temporary infestation of the skin with fly larvae. Travelling to subtropical areas accounts for a higher risk and increasing incidence in Europeans. In Middle- and South American myiasis is mainly caused by the botfly (Dermatobia hominis). Blood-suckling arthropods, usually mosquitoes, transmit the larvae of the botfly via phoresis, a unique mechanism of egg deposition. In Africa cutaneous myiasis is mostly due to the tumbu fly (Cordylobia anthropophaga). Infection with the tumbu fly larvae occurs after direct contact with the eggs that are often deposited in clothes and towels. Clinically an abscess-like lesion develops. Creeping sensations of movement under the skin are occasionally described. Following hatching, spontaneous healing can normally be expected, although extraction of the larvae is recommended to prevent abscess formation and superinfection.

Adult↗
PubMed1998

[Adult-onset Still's disease and its characteristic rash].

Still's disease was originally described as one form of rheumatoid arthritis in children beginning with fever and other systemic symptoms. In rare cases it may also begin in the adult and is then referred to as adult-onset Still's disease. The diagnostic criteria include typical rash, arthralgias, bouts of fever, and leukocytosis, as well as lymphadenopathy or splenomegaly, liver dysfunctions, noninfectious angina, and absence of rheumatoid factor and antinuclear antibodies. We report two adult patients with longstanding disease whose exanthema guided us to the correct diagnosis. The rash is a finding with high sensitivity. It is characterized by red macules with distinct borders and is evanescent. During an acute flare of the rash, gentle friction induces erythematous, isomorphic (Koebner) phenomena, which, as we describe here for the first time, may persist longer than the remainder of the fleeting rash.

Adult↗
PubMed1997

[Therapy studies in dermatologic oncology. Recommendations for patient education].

Guidelines of good clinical practice regulate controlled clinical studies. Goal of the study, type of treatment and possible side effects have to be explained. The physician faces problems, if the study includes a "no treatment group". Referring to the literature and based on our own experience with tumor patients, several criteria are proposed to optimize the recruitment of patients. Important points are: Explanations should be given by an experienced doctor. He must be informed about the study and therapeutic alternative treatments. The atmosphere for the talk must be quiet. The participation of a person whom the patient trusts is desirable. The necessity of the study must be explained. Randomization in different study groups should be discussed without any preference. Prognosis should be explained without any detailed statistical data. Form of treatment, possible side effects and control examinations have to be discussed. The family physician's cooperation should be stressed. Personal autonomy in the patient's decision to participate in the study must be emphasized. Enough time for reflection must be granted before the final decision. It must be assured that the patient receives the same medical attention even after rejecting the study. These recommendations might help to avoid major mistakes which are harmful for the doctor-patient-relationship and further tumor therapy. A good initial discussion forms the basis for effective cooperation during tumor treatment. It may counteract the personal fear and negative reports in media of being "a guinea pig". The patient will appreciate the efforts of the doctor to provide optimal therapy. Furthermore, he will realize that such studies are necessary to improve future therapies.

Humans↗
PubMed1997

[Treatment of lung metastases from malignant melanoma with IL-2 inhalation therapy].

Seven patients with pulmonary metastases of malignant melanoma were treated with inhalation therapy with 36 million IU interleukin-2 for six months. Inhalation therapy was combined with four bolus infusions of DTIC at a dose of 850 mg/m2 once every four weeks. Response rates were 71.4% with 2 patients achieving a complete remission (CR), 2 partial remissions (PR), 1 stable disease (SD), and 2 progressing disease (PD). Therapy was well tolerated with low toxicity. Six of the patients developed cough; one patient was slightly feverish. We conclude that inhalation therapy of lung metastases is a promising addition to the therapeutic arsenal against malignant melanoma.

Administration, Inhalation↗
PubMed1997

A novel dinucleotide mutation in keratin 10 in the annular epidermolytic ichthyosis variant of bullous congenital ichthyosiform erythroderma.

Annular epidermolytic ichthyosis has recently been delineated as a distinct clinical phenotype within the spectrum of epidermolytic keratinization disorders. The pattern of inheritance of the disorder is consistent with an autosomal dominant mode of transmission. Here we report a second incidence of this disorder in a family with two affected generations. The proband suffered from bullous ichthyosis and had bouts of disease activity associated with the development of numerous annular and polycyclic erythematous, hyperkeratotic plaques on the trunk and the proximal extremities. Histologic examination showed the typical pathology of epidermolytic hyperkeratosis, and ultrastructural analysis revealed abnormal keratin filament networks and tonofilament clumping with a perinuclear distribution. Molecular analysis revealed a novel tandem CG to GA 2-bp mutation in the same allele of keratin 10 in affected individuals, resulting in an arginine to glutamate substitution at residue 83 (R83E) of the 2B helical segment. We conclude that annular epidermolytic ichthyosis should be considered a variant of bullous congenital ichthyosiform erythroderma.

Adult↗
PubMed1995

[Life threatening angioedema caused by acquired C1 inhibitor deficiency associated with paraproteinemia and livedo racemosa].

A 61-year-old patient with life-threatening angioneurotic oedema was found to have an acquired C1-inhibitor (C1-INH) deficiency. In addition to lowered serum levels of C1-INH (both protein concentration and enzymatic activity), C2, C4 and CH50, which are characteristic for the hereditary form of angioneurotic oedema, markedly lowered C1q was found, which is typical for the acquired form. There were no antibodies against C1-INH. Repeated thorough examination disclosed no neoplasm, though the presence of neoplasm has often been reported to be associated with the acquired C1-INH deficiency. However, the patient showed persistent paraproteinaemia and paraproteinuria and developed livedo reticularis. Treatment with danazol resulted in a rise of the complement fraction levels and cessation of angioneurotic oedema. Paraproteinaemia and livedo reticularis persisted unchanged.

Angioedema↗
PubMed1995

Chronic urticaria, arthralgia, raised erythrocyte sedimentation rate and IgG paraproteinaemia: a variant of Schnitzler's syndrome?

Schnitzler's syndrome is a distinct disease entity characterized by the association of chronic urticaria, intermittent fever, arthralgia, elevated erythrocyte sedimentation rate and IgM macroglobulinaemia. We report a patient with the same symptoms, but a monoclonal IgG instead of IgM gammopathy. Histological examination of the urticarial lesions showed signs of mild leucocytoclastic vasculitis. Except for the different class of the monoclonal immunoglobulin, the clinical symptoms, laboratory findings and histology in this patient were identical with those in classical Schnitzler's syndrome. IgG and IgM paraproteins may be equivalent with regard to the putative pathophysiology of the disease process in Schnitzler's syndrome. We therefore suggest that the spectrum of Schnitzler's syndrome is expanded to include patients with chronic urticaria and monoclonal IgG gammopathy, as a closely related variant.

Arthralgia↗
PubMed1994

Basal cells of the human epididymis--antigenic and ultrastructural similarities to tissue-fixed macrophages.

Very little is known about the basal cells in the epididymal epithelium. Their function is unclear, although they are present in all mammalian epididymides studied. The corpus epididymides from five patients undergoing castration because of prostatic carcinoma were fixed and processed for electron microscopy. Basal cells were characterized by a slightly heterochromatic nucleus with prominent nucleolus, pale round mitochondria, dispersed endoplasmic reticulum, and sparse Golgi apparatus; they were often rich in lipofuscin inclusions, possibly originating from principal cells. Some peritubular macrophages in close proximity to the epithelium were structurally similar to basal cells. Immunohistochemical staining revealed in the epididymides of another ten patients that the basal cells were recognized by the monoclonal antibody (mAb) 25F9 against mature, tissue-fixed macrophages but not by mAbs 27E10 or RM3/1, which were against activated macrophages usually found in acute or late inflammation, respectively. On the basis of the present findings, as a working hypothesis a scavenging role of the basal cells in a local immune defense mechanism is proposed, in which antigenic products (possibly of sperm degradation), taken up by the principal cells, would be phagocytosed by the basal cells. It could be inferred that when the basal cells are overloaded, they would leave the epithelium to be replenished by tissue-fixed macrophages.

Aged↗
PubMed1993

Immuno-competent cells in the murine epididymis following infection with Escherichia coli.

Epididymitis was induced by retrograde injection of Escherichia coli into the vas deferens of 28 mice. A group of 28 saline-injected animals served as controls. On Days 1, 3, 7 and 28, groups of seven animals were killed. Bacterial culture was performed. Leucocyte numbers and distribution were determined in epididymides. In infected mice, E. coli were isolated from all epididymides on Days 1 and 3, but only from five of seven epididymides on Days 7 and 28. One week after infection, the total number of macrophages rose from about 10 to 28%. Significantly increased macrophage percentages were also found in animals killed 28 days after infection. A simultaneous increase in MHC class II positive cells was seen on Day 7. A total of 20% of the cells expressed MHC class II in infected epididymides (normal = 6%). A similar increase was found on Day 28 after infection. Most of the macrophages and MHC class II positive cells were located in the interstitium, fewer in the peritubular layer and nearly none in the epithelium. The main increase in these cells occurred in the interstitium and, to a lesser but significant extent, in the peritubular area. T-helper and T-suppressor/cytotoxic lymphocytes reached peak values on Day 28. The increase in T-lymphocytes and simultaneous appearance of plasma cells followed the increase in numbers of macrophages and MHC class II positive cells. They were located mainly in the interstitium. A sequential increase in leucocyte subsets and negative culture results for E. coli were observed on Days 7 and 28 (2/7 on each day). The inflammatory process was restricted to the interstitium.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Depot gonadotropin-releasing hormone agonist blunts the androgen-induced suppression of spermatogenesis in a clinical trial of male contraception.

Thus far, when tested as male contraceptives, GnRH agonists in combination with androgens were not very effective in producing azoospermia. Since in previous studies androgens were always given simultaneously with the GnRH agonist or later, we tested whether GnRH agonist administration after an initial androgen suppression phase might yield better results. After a control period, 3 groups of young healthy men (n = 8/group) received an initial loading dose of 400 mg 19-nortestosterone hexyloxyphenylpropionate (19NT-HPP), followed by 200 mg of the ester every 3 weeks for 24 weeks. One week after the first 19NT-HPP injection, 2 groups were given a single sc implant injection of 3.3 or 6.6 mg of the GnRH agonist buserelin, respectively, whereas a placebo implant was given to the third group. In the group receiving only 19NT-HPP, serum LH and FSH were markedly suppressed and remained low during the treatment phase. In the 16 volunteers receiving the buserelin implant LH and FSH were also suppressed on day 7, followed by a marked increase in the gonadotropins up to 2 weeks after buserelin implant injection. While LH was consistently suppressed for the remaining treatment phase, FSH returned to almost normal values in weeks 9-15. In contrast to the group treated with 19NT-HPP alone, in which sperm concentrations were reduced to oligozoospermia after only 3 weeks of treatment, the first suppressive effect in the 19NT-HPP/buserelin-treated groups was not seen before week 9. After 30 weeks, when the maximal suppression of spermatogenesis was seen, 4 of 8 volunteers in the group treated with 19NT-HPP alone were azoospermic, and the remaining 4 volunteers were oligozoospermic. In the groups treated with 19NT-HPP/buserelin, no more than 4 of 16 volunteers were azoospermic, and no more than 8 of 16 volunteers were oligozoospermic at any time point. It is concluded that GnRH agonist depot preparations have a blunting effect on the suppression of pituitary and testicular function caused by androgens in men participating in contraceptive trials.

Adult↗
PubMed1990

Presence and distribution of leucocyte subsets in the murine epididymis after vasectomy.

Male mice were vasectomized by 'open-ended' or 'closed' techniques. After 4 weeks the cell-mediated immune reactions were compared with those of sham-operated animals by immunohistochemical localization of leucocytes, using specific monoclonal antibodies. Macrophages and MHC class II antigen-positive cells were the major cell types to appear in all regions of the epididymis after both types of operation. There was recruitment of T-helper/inducer leucocytes but not of T-suppressor-cytotoxic cells. An increased presentation of macrophage-migration inhibiting factor antigen appeared in interstitial and peritubular locations. After 'closed' and 'open-ended' vasectomy granulomata developed in the epididymis. The sperm-containing lumen of these granulomata was invaded by macrophages, MHC class II-positive cells and T-helper/inducer lymphocytes. This mouse model thus reveals a significant epididymal inflammatory response of the epididymis to vasectomy.

Animals↗
PubMed1990

Improvement in the assessment of human epididymal function by the use of inhibitors in the assay of alpha-glucosidase in seminal plasma.

Seminal alpha-glucosidase has been used clinically as a marker of epididymal function. In this study enzyme inhibitors were used to increase the specificity of the human seminal alpha-glucosidase assay and improve its diagnostic value as an indicator of distal epididymal occlusion in cases of azoospermia. Sodium dodecylsulphate was added to the sample to eliminate the interfering acid isoenzyme secreted by the prostate gland, and castanospermine was used with semen pools to provide a semen blank for the assay by eliminating non-glucosidase-regulated degradation of the substrate. With both inhibitors included in the assay, glucosidase activity in semen samples from 17 fathers was measured to provide reference values for the clinic (lower threshold 18 mU per ejaculate). With the improved assay glucosidase was non-detectable in 8 out of 11 cases of proven and 5 out of 8 cases of suspected ductal obstruction; other azoospermic patients with distal occlusion had values below 11 mU per ejaculate.

Acarbose↗
PubMed1989

Pattern of compartmentation in human seminiferous tubules showing dislocation of spermatogonia.

The pattern of compartmentation of the seminiferous epithelium was investigated, using a lanthanum tracer technique, in human testicular biopsies of adult infertile men (age 27 to 44 years), where dislocation of spermatogonia from the basal lamina occurred. Spermatogonia type A and B were found in a two- or three-layered arrangement, in aberrant locations throughout the seminiferous epithelium, and in intratubular positions associated with fragments of Sertoli cell cytoplasm. Tracer impregnation was found around spermatogonia in a multilayered arrangement, indicating the extension of the basal compartment in a luminal direction. Single spermatogonia within the second or third layer of the seminiferous epithelium were regularly found to be surrounded by tracer. The junctional complex between the lateral membranes of adjacent Sertoli cells was devoid of tight junctions. Tracer penetration around spermatogonia in a more luminal position was prevented by intact Sertoli cell junctional complexes; tracer was also absent from intraluminal located spermatogonia associated with cytoplasmic fragments of Sertoli cells. The luminal extension of the basal compartment associated with the dislocation of spermatogonia clearly differs from the pattern of compartmentation during the movement of primary spermatocytes within undisturbed epithelium. There is a strong incidence of elevated serum levels of follicle-stimulating hormone (greater than 7 U/l), indicating a suppression of Sertoli cell function; this may be the cause for the dislocation of spermatogonia and the changes of compartmentation.

Adult↗
PubMed1989

Immuno-competent cells in the murine epididymis.

Cryostat sections of epididymides from mice were stained with monoclonal antibodies against immuno-competent cells. This investigation was undertaken to gain basic data about the distribution of macrophages. T lymphocytes, MHC class II and MIF in the normal murine epididymis to establish the mouse as a model for immunological epididymal research. The most important findings were as follows. (1) Macrophages, T lymphocytes, MHC class II and MIF positive cells were distributed similarly in the caput, corpus and cauda epididymis. (2) Macrophages were the most frequent leucocytes and the majority were located in the peritubular layer. (3) The MHC class II determinant was also expressed mostly in the peritubular layer and interstitium. These cells were similar in appearance and location to macrophages. (4) Significantly fewer T lymphocytes were found and their main location was the interstitium. T-helper and T-suppressor/cytotoxic lymphocytes did not differ significantly in their regional or histological distribution patterns. (5) The ratio of T-helper to T-suppressor/cytotoxic lymphocytes was 1:1. (6) MIF was detected almost exclusively in blood vessels and the surrounding connective tissue. (7) No invasion of leucocytes into the epididymal lumen was observed. It is concluded that macrophages seem to be the most important immunological cell type in the murine epididymis.

Animals↗
PubMed1989

Objective measurement of testicular volume by ultrasonography: evaluation of the technique and comparison with orchidometer estimates.

Ultrasonography of the scrotum is a valid and safe method for differentiating testicular and extratesticular disease. In the present study the accuracy and reproducibility of ultrasonographic estimation of testicular volume was evaluated. A high correlation (r = 0.992) between actual testicular volume (measured by weighing and water displacement) and the volume determined by ultrasonography was found on examination of 14 tests from patients at autopsy without any systematic under- or over-estimation. The ultrasound method proved to be highly reproducible with a coefficient of variation of 7.0 +/- 0.7%. Using different ultrasound scanners did not significantly influence the results obtained. The comparison of Prader orchidometer measurements, performed by four different clinical investigators, and ultrasonography in 256 patients revealed a significant correlation of 0.91, but the degree of correlation was dependent on the investigator's clinical experience. Volume estimates by comparative palpation appear to be valuable in most clinical settings. Ultrasonography provides an excellent tool for determining testicular volume when objective, accurate and reproducible measurements of testicular volume are required.

Evaluation Studies as Topic↗
PubMed1989

The antimycotic drug terbinafine in contrast to ketoconazole lacks acute effects on the pituitary-testicular function of healthy men: a placebo-controlled double-blind trial.

Among the side-effects of the antimycotic drug ketoconazole, inhibition of testosterone biosynthesis is highly pronounced. The decrease in testosterone may cause impotence and gynecomastia, and this side-effect has been exploited in drug tests for the treatment of androgen-dependent tumours. Terbinafine, an allylamine derivate, from a new group of antifungal substances, did not show similar inhibiting effects on steroid synthesis in vitro and in vivo in animal experiments. In a double-blind, placebo-controlled study the influence of terbinafine and ketoconazole on the pituitary-testicular axis in normal young men were compared. Serial blood sampling for 12 h was followed by the ingestion of the placebo, ketoconazole (200 mg) or terbinafine (500 mg) on three different occassions in random order. Ketoconazole administration caused a steep decrease of serum testosterone reaching a nadir after 4-5 h. Simultaneously an increase in 17-hydroxyprogesterone occurred with peak values after 5 h. During 12 h after the administration of ketoconazole no changes in LH pulse frequency and amplitude were found, although testosterone serum levels were in the subnormal range for about 8-9 h. Terbinafine showed no effects on testosterone and 17-hydroxyprogesterone levels or on LH pulse frequency and amplitude. Estradiol, prolactin and FSH remained unchanged after ketoconazole and terbinafine ingestion compared with placebo treatment. The study confirms the acute effect of ketoconazole on serum testosterone and 17-hydroxyprogesterone, whereas terbinafine shows no acute influence on the pituitary-gonadal axis.

17-alpha-Hydroxyprogesterone↗