Hypomelanosis due to block of melanosomal maturation in amiodarone-induced hyperpigmentation.
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Amiodarone↗
Biomedical subjects
N Haas
Publications and source records attributed to N Haas.
The use of ELM to monitor the success of antiscabietic treatment. Epiluminescence light microscopy.
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Administration, Cutaneous↗
Preoperative B-mode ultrasound plaque appearance compared with carotid endarterectomy specimen histology.
In carotid artery stenosis both the degree of the lesion and its plaque morphology are thought to be associated with the carrier's thromboembolic risk. In this study we evaluated the diagnostic preciseness of non-invasively B-mode ultrasound in predicting the histopathological plaque structure. We examined 44 patients with > 50% ICA stenosis by B-mode within 6 weeks prior to carotid endarterectomy. At the affected bifurcations, up to 10 different regions of interest (ROI) per artery were investigated. Plaque appearance was classified according to 6 subtypes considering different ultrasonic plaque features. Postoperatively, plaque specimens were examined histopathologically for their relative content of calcification, fibrous tissue and different soft tissue. B-mode ultrasound was compared with histopathological features in ROI. A total of 265 regions of interest were evaluated. In mainly echolucent types of plaques, atheromatous debris was most frequently seen, whereas fibrosis was rare. Homogeneous echolucent plaques showed a high proportion of cholesterol and/or recent haemorrhage. Thrombosis at the plaque surface was often seen in "completely echolucent" plaque type (each P<0.001). Carotid B-mode ultrasonography is able to predict the histopathological components and the texture of carotid plaques.
Adipose Tissue↗
Erythema elevatum diutinum--evidence for disease-dependent leucocyte alterations and response to dapsone.
Erythema elevatum diutinum (EED) is a type of leucocytoclastic vasculitis of unknown aetiology. We report a patient with unusually widespread and disabling EED that had been unresponsive to corticosteroids and antibiotics, but resolved on dapsone. Biopsies of fresh lesions showed typical features of leucocytoclastic vasculitis, with prominent neutrophil infiltration, marked expression of the beta(2)-integrins CR3 and LFA-1, and increased mast cell numbers. Older lesions exhibited granulation tissue and fibrosis, macrophages were more dominant, beta(2)-integrins were expressed less markedly, and mast cell numbers were lower. In vitro chemotaxis of the patient's peripheral blood neutrophils prior to treatment showed increased random migration and directed migration towards interleukin-8 (by 424%), but a profoundly decreased responsiveness towards the bacterial peptide analogue N-formyl-methionyl-leucyl-phenylalanine (fMLP) (by 98%). These values returned to normal after dapsone treatment and clinical improvement 5 months later. These findings support the concept that in EED, activation via cytokines such as interleukin-8 allows a selective recruitment of leucocytes to tissue sites, while immune complexes and bacterial peptides sustain the persistent local inflammatory infiltrate and the leucocytoclastic vasculitis.
Anti-Inflammatory Agents, Non-Steroidal↗
Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma of the forefoot.
Mycetoma is a localized primary subcutaneous infection due to fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who acquired an implantation infection on the forefoot following a motorcycle accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were isolated simultaneously from the lesion. Under combined therapy with itraconazole and trimethoprim-sulphamethoxazole for 7 months the lesion healed completely. A combination of causative organisms in mycetomas is rare, and the combination of S. schenckii and N. asteroides together has not been reported from one lesion.
Aged↗
Granulation tissue flap technique in extensive wounds for covering exposed bone after tumor excision.
BACKGROUND: Second intention partial wound healing followed by skin grafting is a well-established method in dermatosurgery. In wide tumor excision, where periosteum is removed, growth of granulation tissue in the central areas of bare bone can be prolonged. OBJECTIVE: We describe a new technique for a faster, reliable closure of large defects utilizing granulation tissue flaps. METHODS: Postoperative wounds were treated with wet dressings until granulation tissue had developed on the wound edges. The central defects were then covered with lateral granulation tissue flaps. Subsequently split skin grafting was performed. RESULTS: Thirty-eight patients (37-99 years old) were treated between 1991 and 1999. Skin defects were located primarily on the scalp and forehead, and ranged from 3 to 13 cm in diameter. Wound bed preparation for skin grafting was achieved in all patients. Only minor complications, such as partial granulation flap necrosis in 5 of 38 patients or delayed skin graft healing in 4 of 38 patients, were seen. CONCLUSIONS: This technique for the closure of extensive skin defects is safe and effective.
Adult↗
[Laparoscopic therapy of diaphragmatic rupture on both sides].
The usual treatment for operative repair of diaphragmatic injuries is laparotomy or thoracotomy. We report on a 26-year-old patient, who was treated by laparoscopic surgery for a rupture on both sides of the diaphragm. The operation was without complications and the advantages of minimally invasive laparoscopic surgery were clearly evident. There was much less strain on the patient and the postoperative recovery period was short. In addition, for unclear findings there is a high diagnostic potential in laparoscopy. The rupture on the right side of the diaphragm was not diagnosed until laparoscopy, although our patient underwent extensive diagnostics prior to the intervention.
Adult↗
Upregulation of TNF-alpha and IL-3 expression in lesional and uninvolved skin in different types of urticaria.
BACKGROUND: Although mast cells are known to secrete a broad spectrum of proinflammatory and immunomodulatory cytokines, the role of these molecules in mast cell-dependent cutaneous inflammation is not clear. OBJECTIVE: We decided to study biopsy specimens from lesional and nonlesional skin of patients with acute, chronic recurrent, delayed pressure, and cold urticaria; from fleeting wheals of prick test reactions to allergens; and from normal skin of nonallergic subjects. METHODS: Cryostat sections were stained by immunohistochemistry with antibodies against IL-3, IL-8, TNF-alpha, and mast cell-specific tryptase. In serial sections with tryptase and each cytokine, reactivity of mast cells was studied as well. RESULTS: Compared with normal skin and prick test reactions, immunoreactivity for TNF-alpha and IL-3 was significantly increased on endothelial and perivascular cells of the upper dermis in all urticaria lesions. In nonlesional skin comparable upregulation was noted on endothelial cells and for TNF-alpha on perivascular cells of patients with delayed pressure urticaria. In addition, TNF-alpha was expressed throughout the epidermis in lesional and nonlesional skin of patients with all types of urticaria, but not in normal control subjects. Sequential biopsy specimens from patients with cold urticaria showed upregulation of TNF-alpha and IL-3 on endothelial cells 30 minutes after elicitation of lesions with an ice cube. In contrast to these findings, epidermal immunoreactivity, as well as endothelial and perivascular cell expression of IL-8, were only slightly altered in urticaria compared with normal skin. In sequentially stained sections, few tryptase-positive mast cells reacted to TNF-alpha, few reacted to IL-3 in pressure urticaria only, and practically none stained for IL-8. CONCLUSION: These findings suggest that the cytokines studied here are involved in the pathology of urticaria, possibly by inducing subthreshold inflammation in endothelial cells of uninvolved skin.
Cytokines↗
Digital radiography. A predictor of regenerate bone stiffness in distraction osteogenesis.
The newly formed regenerate bone during limb lengthening usually is assessed by observing standard plain radiographs. However, no objective data correlate the radiographic appearance with the quantitative strength of the newly formed bone. A noninvasive method was developed to assess the regenerate bone using digital radiography. The investigations were performed in a micropig animal model. The right tibia was distracted for 10 days at 2 mm per day. Digital radiography was performed after the distraction during a 10-day consolidation period. For quantitative analysis, an aluminum step wedge was placed on all images, and a region of interest was outlined in the regenerate bone. A calibration curve was calculated by measuring the corresponding gray values of the aluminum phantom. The calibration equation was used for determining the mean density in the region of interest. This method was sensitive in assessing day to day healing progress. The measurements taken the day before sacrifice were compared with torsional mechanical data using a material testing machine. The high correlation between the densimetric evaluations and the biomechanical data suggests this method is a useful tool for in vivo assessment of the regenerate bone during the consolidation period in distraction osteogenesis.
Absorptiometry, Photon↗
Microscopic morphology of different types of urticaria.
OBJECTIVE: To identify possible special histopathologic features of different types of urticaria. DESIGN: Hematoxylin-eosin- and toluidine blue-stained sections from biopsy specimens of all patients with urticaria seen from 1990 to 1993. SETTING: Inpatient and outpatient services of the Virchow Klinikum, Humboldt University, Berlin, Germany. PARTICIPANTS: We studied spontaneous or induced wheals of 108 patients with acute, chronic, and physical urticaria who consented to an additional biopsy from uninvolved skin. The controls were 10 normal volunteers with wheals that tested positive on a prick test and who had contralateral normal skin. MAIN OUTCOME MEASURE: Mast cell numbers in both lesional and nonlesional skin in the upper and lower dermis of biopsy specimens from patients and controls. RESULTS: Blind evaluations of microscopic sections showed dermal edema and dilated lymphatic and vascular (P < .001 for all, Fisher exact test) capillaries almost exclusively in involved skin. The same held for inflammatory infiltrates, with significantly increased numbers of neutrophils and eosinophils in specimens from patients with acute urticaria and those with delayed pressure urticaria (P < .01 for each). Mast cell numbers were higher in the upper (P < .01) and lower dermis (P < .05) of lesional and uninvolved skin of all patients with urticaria, with a further increase (P < .01) in patients with disease of more than 10 weeks' duration. Edema and vascular changes were most prominent in the skin of patients with cold urticaria (P < .005) and mononuclear infiltrates were more pronounced in those with cold urticaria, chronic urticaria, and prick test-positive wheals (P < .05 for each) and in the lower dermis of patients with delayed pressure urticaria (P < .001). CONCLUSIONS: In all types of urticaria, mechanisms must be operative that cause an increase of cutaneous mast cells. Distinctive pathological features can be identified in different types of urticaria, although these are not diagnostic.
Acute Disease↗
Anterior cruciate ligament reconstruction: the diagnostic value of MRI.
A prospective study was carried out in order to evaluate the predictive value of MRI in the early postoperative course after cruciate ligament replacement. Twenty patients who had undergone anterior cruciate ligament reconstruction using autologous patellar tendon/bone grafts were examined clinically and with contrast enhanced MRI at 2, 12 and 24 weeks, and 1 and 2 years after operation. The clinical findings were evaluated according to the scores established by Lysholm, OAK and IKDC. The MRI scans (SP 63, 1.5 Tesla) were assessed in terms of the quality and signal intensity of the reconstructed ligaments. During the first postoperative year there was a significant increase of signal intensity and in homogeneity of the neoligament on in the MRI. Seventeen patients had an average value for signal/noise of 1.1 at two weeks after surgery, which had increased to 7.1 at 1 year. In 14 patients the reconstructed ligament could not be evaluated in MRI scans after 1 year but clinical instability was not suspected in any of these patients. Two years after operation the MRI signal, intensity of the neoligament was again decreasing.
Adolescent↗
Neutrophilic urticaria: clinical features, histological changes and possible mechanisms.
Neutrophilic urticaria (NU) is a histologically defined entity, but its clinical and pathogenetic aspects are poorly understood. We investigated 22 NU patients whom we identified by examining 118 biopsies of weals. The patients comprised 11 of 20 with acute urticaria, nine of 49 with chronic urticaria, one of 10 with cold urticaria and one of 10 controls undergoing prick tests. Clinically, NU patients had a shorter mean duration of disease than other urticaria patients and significantly increased erythrocyte sedimentation rate and leucocytosis. Histologically, not only neutrophil counts, but to a lesser extent also eosinophil counts and mononuclear cell infiltrates were significantly increased in lesional skin of NU, and there was more marked vasodilatation and endothelial swelling. On immunohistochemistry, increased tumour necrosis factor alpha and interleukin (IL)-3 expression was noted, compared with other urticarias, whereas IL-8 expression was only minor. These data characterize NU as an acute phase urticarial reaction associated with an intense inflammatory infiltrate and marked upregulation of some mast cell-derived cytokines.
Acute Disease↗
Multicentric reticulohistiocytosis indicating metastasis of an unknown primary tumour.
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Adult↗
Differential endothelial adhesion molecule expression in early and late whealing reactions.
In order to clarify the pathomechanisms of fleeting versus more persistent wheals, expression of endothelial adhesion molecules was studied in biopsies of lesional and uninvolved skin of 15 patients with different types of whealing reactions, using immunohistochemistry. In wheals of < or = 30 min duration, no increase of ELAM-1 and ICAM-1 was noted. GMP-140 expression was absent in prick tests, but could be demonstrated in lesions of cholinergic and cold urticaria, with a gradual increase of the latter with time. In wheals of > or = 6 h duration, GMP-140 was only weakly expressed whereas ELAM-1 and ICAM-1 were markedly up-regulated in lesional and less so in nonlesional skin of acute, chronic recurrent and delayed pressure urticaria. This differential expression of endothelial adhesion molecules may reflect the activity of mast cell-derived and other mediators during the elicitation phase and explains the persistence of wheals in different types of urticaria.
Allergens↗
Pinless external fixation. Indications and preliminary results in tibial shaft fractures.
A major drawback of conventional fixator systems is the penetration of the fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and the outer environment. The new AO pinless fixator bypasses this disadvantage by clamping its trocar points onto the outer cortex without penetrating it. Thus, exposure and consequent contamination of the medullary cavity does not occur. The clinical use of this easily manageable fixator with no drilling requirement is for tibial fractures in which the general and local conditions are poor or the infrastructure of the clinic is inadequate for primary internal stabilization or both. All options for a later conversion to internal fixation remain open. For highly unstable tibial shaft fractures, the pinless fixator can be applied as an additional, minimally invasive, external, locked system to increase the stability of intramedullary nail fixation. The pinless external fixator can be combined favorably with the standard AO tubular system and is a valuable addition to the existing fixator systems.
Adolescent↗
Low dose angiotensin converting enzyme inhibition and glomerular permselectivity in renal transplant recipients.
In this study, we determined the fractional clearance of neutral polydisperse dextrans (theta D) and monodisperse dextran sulfate (theta DS) to describe glomerular size and charge selectivity in 25 renal transplant recipients with proteinuria. Thirteen were treated with low dose lisinopril for six months (group 1) and 12 patients without ACE inhibitor therapy formed group 2. Mean arterial blood pressure was stable (group 1, 112 +/- 4; group 2, 109 +/- 2 mm Hg at baseline and after 6 months) whereas creatinine clearance, glomerular filtration rate and renal plasma flow decreased nonsignificantly but were comparable at any time. Lisinopril treatment lowered filtration fraction (22 +/- 2 vs. 19 +/- 2%, P = 0.07) whereas no change was seen in group 2 (20 +/- 2%). The fractional protein excretion (mg urinary protein per day/ml creatinine clearance per day) was stable in group 1, but significantly increased in group 2. The same pattern was found for theta D larger than 56 A. theta DS was stable and consistently elevated in both groups at any time. We conclude that low dose ACE inhibitor treatment in proteinuric renal transplant recipients stabilizes glomerular size selectivity independently of its systemic hemodynamic effects.
Angiotensin-Converting Enzyme Inhibitors↗
Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis.
RATIONALE AND OBJECTIVES: This study assessed the diagnostic potential of magnetic resonance imaging for the evaluation of the tibiofibular syndesmosis. METHODS: A total of 38 patients with an acute ankle trauma and clinical suspicion of a syndesmotic tear were prospectively studied with conventional plain film radiography and magnetic resonance imaging. Magnetic resonance imaging studies included plain T1-weighted (T1-w) and T2-weighted (T2-w) sequences and contrast-enhanced T1-w sequences 0 to 3 days after trauma. All images were read by two independent radiologists before surgical intervention. Sensitivity and specificity were determined for the two observers and the concordance of the two observers were calculated using the interobserver analysis (Kappa-Test). Intraoperative inspection (n = 21) revealed rupture of the anterior tibiofibular ligament (ATIF) in 15 patients, intact ATIF in 6 patients, and intact posterior tibiofibular ligament (PTIF) in 21 cases. Clinical and follow-up examinations revealed an intact syndesmotic complex in another 17 patients. RESULTS: Primary diagnostic criteria for diagnosing a ligamentous tear included tibiofibular diastasis in conventional plain films; nonvisualization of the ATIF; an abnormal course, a wavy, irregular contour of the ligament; increased signal intensity of the ligament in T2-w sequences, in plain T1-w sequence, and marked enhancement in T1-w after contrast. Important secondary signs were defined as joint fluid in the tibiofibular space and prolapse of interspace fat. Highest diagnostic accuracy was achieved if three or more diagnostic criteria could be visualized. Both readers performed best with the enhanced T1-weighted and the T2-weighted images in transverse orientation. The interobserver analysis resulted in high concordance: Kappa = 0.9 (confidence interval: 0.76 to 1.00) for all patients, and in Kappa = 0.76 (confidence interval: 0.45 to 1.0) for surgically treated patients. CONCLUSIONS: Magnetic resonance imaging of the syndesmotic complex is a highly sensitive and specific tool for the pretherapeutic-evaluation of syndesmotic injury.
Acute Disease↗
Demonstration of the high-affinity IgE receptor (Fc epsilon RI) on Langerhans' cells of diseased nasal mucosa.
Langerhans' cells in the skin have recently been shown to bind IgE molecules via the high-affinity IgE receptor (Fc epsilon RI). Using two highly specific antibodies against the antibody-binding alpha-chain of this receptor, 29C6 and 6F7, we demonstrate by immunohistochemistry and immunoelectron microscopy that Langerhans' cells of diseased nasal mucosa can express the Fc epsilon RI. Tissue sections from hyperplastic nasal conchae and nasal polyps of atopic and nonatopic patients have shown no basic differences in epithelial Fc epsilon RI-bearing cells. Only a few cells expressed the low-affinity IgE receptor (Fc epsilon RII) (Tü1 antibody) in some sections. These findings suggest that Langerhans' cells play an important role in the induction of transepithelial IgE-mediated allergy and in the mediation of inflammation of the nasal mucosa via their Fc epsilon RI.
Biopsy↗