Biomedical subjects
Publications and source records attributed to F Gschnait.
Clear-cell sarcoma of tendons and aponeuroses represents a rare, malignant tumor. Its knowledge and differential diagnosis is of importance in order to initiate early treatment. A typical case and in particular the histological differential diagnosis will be discussed.
Two cases of acquired zinc deficiency after excessive bowel resection and total pancreatectomy and after total parenteral nutrition are reported. Skin lesions include diffuse hair loss and a psoriasis like dermatitis localized mainly at acral areas and around body orifices, which disappeared rapidly after oral supplementation of zinc sulfate. Clinical symptoms, etiological factors, differential diagnosis and therapy are discussed.
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Abundant evidence suggests that Treponema pallidum (T.p.) escapes humoral immune defence despite the host produces antibodies early in the infection. Since the serologic responses in syphilis have been studied in detail this paper focuses on the cellular immune mechanisms. For this purpose the leukocyte migration inhibition was investigated in 17 patients in different stages of syphilis. Leukocyte migration inhibition assay was performed before, and 7 days, 3 weeks, 2 mo. and 1 yr after start of treatment. Ultrasonicated T.p. were used as antigen corresponding to 5 X 10(6) to 2 X 10(7) Treponema pallida per ml. Controls without antigen, with addition of Concanavalin. A instead of T.p. and using cells of normal volunteers were run. There was no leukocyte migration inhibition before treatment, suggesting nonexistent or depressed cellular immunity in the untreated syphilitic patient. Significant leukocyte migration inhibition, however, was observed as early as 2 days after start of treatment, being most pronounced after 1 week. Hypothetical circulating blocking factors for cellular immune reactions might be present in the untreated syphilitic patient, which become abolished after therapy. Since stimulation with Con A of syphilitic leukocytes gave normal results even before treatment in the syphilitic patient, there might be a specific block of leukocyte migration inhibition against T.p.
Condylomata acuminata are benign epitheliomas which are caused by the human papilloma virus. 8 subgroups (variants) of the virus are known up to now. Condylomata acuminata are infectious, the virus being transferred by direct contact with a lesion. Condylomata acuminata are found more often in males than in females and never occur in children prior to the age of two years. The peak incidence is between 19 and 22 years of age. Greatly proliferating condylomata acuminata (type Buschke-Löwenstein) may lead to malignant degeneration. There exists a broad spectrum of topical therapeutic modalities: cytotoxic substances such as podophyllin (10 to 25%), colchicine (8%), 5-fluorouracil (1 to 5%), cryotherapy (solid carbon dioxyde or liquid nitrogen), surgical treatment (excochleation, electrocautery or laser beam. Vaccination therapy may prove successful in certain cases in the future.
Despite the availability of a broad spectrum of specific and non-specific tests for the serodiagnosis of syphilis, the interpretation of the results may be difficult and may frequently not provide sufficient information for a precise decision on the needs for antisyphilitic treatment. The present paper reports on the serological IgM tests (IgM-FTA-ABS; 19S-IgM-FTA-ABS) and, in particular, on the newly-developed SPHA test (solid phase hemadsorption). Present experience indicates that for the first time in syphilis serology this test unifies the advantages of high specificity, high sensitivity, low costs and extraordinary clinical value for the decision whether or not the patient needs antisyphilitic treatment.
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An unusual case is presented of repeated, life-threatening self mutilation, elicited by the topical application of sodium hydroxide, which necessitated several operations, including amputation of the left lower leg. Histological examination revealed colliquation necrosis and a striking eosinophilia. The latter feature, which was not reproducible in an animal experiment, may be related to a defect of leucocyte locomotion in the present case.
Using the fluorescent treponemal antibody-absorption (FTA-ABS) test and the solid phase haemadsorption assay (SPHA) Treponema pallidum-specific IgA was found in the cerebrospinal fluid (CSF) of patients with neurosyphilis but not in those with late latent syphilis. The presence of T pallidum-specific IgA in the CSF may inhibit the antitreponemal activity of IgG and thus play some part in the pathogenesis of neurosyphilis.
The dermatological symptoms of cryoglobulinemia and the simple demonstration of cryoproteins by cooling of serum and plasma respectively is described in a patient.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
It is well established that suprabasal acantholysis can be produced in tissue culture of normal human skin in the presence of pemphigus IgG autoantibody. In this study, bullous pemphigoid, herpes gestationis and linear dermatitis herpetiformis anti-basement membrane zone antibodies failed to produce dermoepidermal separation in a tissue culture model in spite of the presence of complement. The binding of the antibodies was demonstrated by immunofluorescence and immunoelectron microscopy; ultrastructurally, identical binding sites of anti-basement membrane zone antibodies could be demonstrated in vitro, as has been observed in vivo previously. Tissue culture is a suitable model for studying the binding sites of circulating anti-basement membrane zone antibodies but the functional activity (blister format;on) of these antibodies cannot be assessed thereby.
Polymorphonuclear leukocyte (PMN) and mononuclear cell (MNC) locomotion was investigated in patients with psoriasis vulgaris before and after treatment with oral photochemotherapy (PUVA) and was found to be significantly increased (PMN: p < 0.001; MNC: p < 0.002) when compared to healthy controls. No significant difference was observed in the locomotion of PMN or MNC before and after PUVA treatment. These results indicate that PMN and MNC locomotion is increased in psoriasis vulgaris and remains unaltered by PUVA treatment.
Skin biopsies of 243 patients treated with photochemotherapy (PUVA) for 1--4 years were examined histologically. Two hundred and six patients were examined retrospectively after total cumulative UV-A doses of 579 . 6 +/- 598 . 0 J/cm2 (mean +/- s.d.). An eosinophilic homogenization and a reduction of elastic fibres at the dermo--epidermal junction, and an increase of dermal macrophages were found as possible abnormalities. However, except for the increase of melanophages there was no statistically significant correlation between the incidence of these changes, the total UV-A dose applied and the skin type of the patients. Neither were such correlations found in thirty-seven patients biopsies twice after 394 . 8 +/- 267 . 6 J/cm2 and 808 . 5 +/- 458 . 9 J/cm2 (mean +/- s.d.), respectively. Studies with direct immunofluorescence techniques revealed no immunoglobulin deposits in PUVA treated skin in fifty-six patients after 469 . 2 +/- 370 . 2 J/cm2; antinuclear antibodies were observed in 4 . 6% of 129 patients after 169 J/cm2 (mean); in 11% of fifty-three patients reexamined after 381 J/cm2 (mean) and in 13 . 6% of twenty-two patients reexamined a second time after 643 J/cm2 (mean). Thirteen out of a total of 572 patients developed a peculiar mottling of skin in areas previously overdosed by PUVA. Subepidermal homogenization and reduction of elastic fibres were found in 45% of the patients, indicating that these changes indeed are a consequence of PUVA. Nuclear and cellular irregularities were found in 45% of the biopsies and 63% showed a disturbed epidermal architecture, but no carcinomas were observed. PUVA-induced mottling was reversible in 31%, partially reversible in 15%, but continued to be present in 54%.
Eccrine porocarcinoma is an extremely rare malignant skin tumor arising from the eccrine sweat duct unit (acrosyringium). It presents histologically with nests of clear tumor cells in the epidermis and superficial dermis. In addition such clear tumor cells lie isolated high up in the epidermis, closely resembling Paget cells. The various tumors, which may originate from the acrosyringium and the histologic differential diagnosis of eccrine porocarcinoma are discussed.
The spontaneous occurrence of widespread ecchymoses in a patient not exhibiting coagulopathy leads to a spectrum of differential diagnoses including amyloidosis, anaphylactoid purpura, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, autoerythrocyte sensitization and autosensitization to DNA (11). This paper reports on a patient exhibiting the characteristic clinical findings and skin reactivity indicative of DNA autosensitization. The syndrome will be discussed briefly with particular reference to the differential diagnosis to autoerythrocyte sensitization.