Biomedical subjects
Publications and source records attributed to R Wolf.
Three patients had a rare form of bullous pemphigoid, clinically similar to the erythematous type of bullous pemphigoid without vesiculobullous lesions. All the patients displayed immunofluorescence features of bullous pemphigoid. This form of the disease presents a substantial diagnostic problem because it lacks the principal morphologic feature of bullous pemphigoid, namely the vesicles and bullae.
Fusarium oxysporum was isolated from a large foot ulcer in an otherwise healthy 69-year-old man. Although tissue invasion could not be proven histologically, systemic antifungal treatment was administered with satisfactory response. Fusarium species are common soil-inhabiting organisms and plant pathogens. In humans, Fusarium is considered an opportunistic agent in skin ulcers, interdigital spaces, and burned skin, but can also cause mycotic keratitis, onychomycosis, and rarely deep-seated or disseminated infections, especially in an immunocompromised host. The distinction between skin infection and saprophytic growth, as well as optimal treatment regimens for the two types of infection, have not been clearly defined. We describe a case of leg ulcers caused by Fusarium oxysporum in a 69-year-old man treated successfully with oral ketoconazole. "Silent" immunologic disturbances were found in this apparently healthy patient. The case illustrates a relatively benign infection caused by Fusarium that responded to systemic antifungal drug treatment.
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Clinical research centers in Aarhus, Berlin, Hamilton and Vienna collected mortality data for 827 manic-depressive and schizoaffective patients given lithium treatment for more than 6 months. The average duration of the treatment was 81 months and the total time on lithium 5600 patient-years. For each patient, the mortality risk was calculated by entering the appropriate national life tables for the general population. The number of observed deaths was 44; the number of expected deaths was 49.7. The standardized mortality ratio, 0.89, did not differ significantly from 1.0. The mortality of manic-depressive patients is 2-3 times that of the general population. Our data show that the mortality of manic-depressive and schizoaffective patients given long-term lithium treatment does not differ significantly from that of the general population.
A multicenter randomized 4-week interindividual double-blind study was carried out in 58 hospitalized patients with major depressive disorder (DSM III 296.23, 296.22, 296.33, 296.32, 296.53 and 296.52) to test the dose-effect relationship of three different doses of the new cAMP-phosphodiesterase inhibitor rolipram: 3 x 0.25 mg, 3 x 0.50 mg and 3 x 1.00 mg rolipram/day. With respect to the desired effect, the 3 x 0.50 mg dosage stood out from the others in almost all relevant parameters. With respect to the response rate, the efficacy of the 3 x 0.25 mg dosage was about the same as that reported in the literature for placebo. The inferior performance of the 3 x 1.00 mg dosage compared to the 3 x 0.50 mg dosage might indicate a reverse U-shaped dose-effect relationship. There was good tolerance to all three dosages. There were no findings that might cast doubt on the safety of the dosages tested.
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The rare event of invasive squamous cell carcinoma 70 years after irradiation to the scalp for tinea capitis, occurred in a 75-year-old Caucasian male. The clinical, histological, roentgenologic and magnetic resonance imaging picture are described, and the literature is reviewed.
The mutant no-bridge (nobKS49) has its name from a structural defect in the protocerebral bridge of the central complex. This rod-shaped neuropil in nobKS49 has a large gap at the sagittal midplane, with some of the missing material accumulated more laterally. Mutant nob flies have a reduced maximal and average walking speed. Leg coordination is disturbed during turning but not while walking straight. Motivation for walking is low and steps are small due to slow forward swinging of the legs. Flies spontaneously may pass into an autistic (and possibly spastic) state in which they can move their legs and even perform cleaning movements but do not walk or fly. They spontaneously recover if left undisturbed. Gynandromorph experiments place the focus of the walking defects into the head. Mutant flies have a reduced tendency to escape when mechanically stimulated. In a brightly lit arena they do not avoid a black square above the horizon and they are negatively phototactic. In tethered flight optomotor responses are normal but the amplitude of spontaneous torque modulations as well as the number of torque spikes are reduced. If a single black bar is slowly rotated around the fly, the normal response pattern is observed. It vanishes, however, at moderately fast angular velocity at which the wild type still is fully responsible. The behavioral defects support the notion that the protocerebral bridge is part of a higher center for the regulation of behavior.
Mutations in the complex optomotor-blind (omb) gene locus (4C4-6) lead to a number of different phenotypes in various tissues of the adult Drosophila melanogaster fly. At the core of the locus lies a lethal complementation group, named l(1)omb, whose mutations cause larval and pupal lethality. Some 40% of all males hemizygous for lethal omb alleles develop to the pharate adult stage. These flies can be rescued from the pupal case and show a severe disturbance in optic lobe development. The recessive viable allele In(1)ombH31 reduces the optomotor response in walking flies and during stationary flight of tethered flies. At the neuroanatomical level, these animals lack a subset of lobula plate giant neurons (LPGNs), which are thought to mediate optomotor behavior. Chromosomal aberrations deleting the proximal, non transcribed part of the locus complement the lethality, but still cause neuroanatomical and optomotor defects. Analysis of different allelic combinations of such mutations, in which increasing amounts of DNA downstream of the transcribed region are removed, reveals a step gradient of increasing severity of the neuroanatomical defects and behavioral phenotypes. On this basis the 3'-regulatory region is divided into three domains each having specific effects on optic lobe development.
Three patients with pityriasis alba whose lesions were confined to the knees only are reported. Such cases can be misdiagnosed as psoriasis. The key to the correct diagnosis lies in the physician's awareness of the existence of this variant of pityriasis alba.
Presented are two patients who developed an unusual, and as yet unreported eruption due to amoxycillin. They exhibited an eruption confined to the intertriginous areas, which mimicked intertrigo. Although drug eruption can mimic a variety of idiopathic skin diseases, intertrigo is easily distinguished from drug eruption and has not been mentioned in the differential diagnosis of this reaction. It is suggested that drug reactions should be considered in the differential diagnosis of intertrigo, in particular of atypical and therapy-resistant cases. Early detection of these cases has practical importance since the elimination of the causative drug is essential for therapy success. Case 2 showed a response of the toxic epidermal neurolysis (TEN) type, which could have been very severe and dangerous had the diagnosis not been made in an early stage before the development of generalized TEN.
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Challenging a hypersensitive patient with a potentially harmful drug is most important to the development of medical knowledge. However, it does not always serve the interest of the particular patient. In order to protect the interest of an individual patient, one must abstain from challenge unless it is vital to the health of the particular patient at the time and has no substitute. Patients' rights demand the establishment of limitations and guidelines for the procedure of rechallenge in all its aspects. An approach which will bring physicians closer to a solution, which will protect the patient from uncontrolled decisions and from unnecessary risks, is suggested.
The results of patch tests in one hundred patients were classified according to the site of clinical involvement. None of the twelve patients with clinical contact dermatitis of the eyelids had a positive patch test reaction when tested with a routine screening patch test tray. More than 50 percent of the patients with contact dermatitis in exposed areas other than the eyelids had one or more positive results of epicutaneous tests. Although we cannot explain why standard patch test reactions are unsatisfactory indicators of eyelid dermatitis, this fact has significant clinical importance.
Operant behavior is studied in tethered Drosophila flies using visual motion, heat or odour as operandum and yaw torque, thrust or direction of flight as operans in various combinations (Fig. 1). On the basis of these results a conceptual framework of operant behavior is proposed: (1) It requires a goal (desired state) of which the actual state deviates. (2) To attain the goal a range of motor programs is activated (initiating activity, see Fig. 7). (3) Efference copies of the motor programs are compared to the sensory input referring to the deviation from the desired state (e.g. by cross-correlation). (4) In case of a significant coincidence the respective motor program is used to modify the sensory input in the direction towards the goal. (5) Consistent control of a sensory stimulus by a behavior may lead to a more permanent behavioral change (conditioning). In this scheme operant activity (1-4) and operant conditioning (1-5) are distinguished.
The activity of L-glutamic acid decarboxylase (GAD) is commonly estimated by several radiometric methods, whereas a fluorimetric assay based on an enzymatic formation of NADPH as described by Y. Okada and C. Shimada [(1975) Brain Res. 98, 202-206] has been given little attention in biochemical and pharmacological investigations. A simple modification of this assay is presented to permit rapid and sensitive GAD measurements in unpurified tissue homogenates. This method, employing a linear NADPH standard curve, is demonstrated to be a valid assay system for a pharmacological approach using 3-mercaptopropionic acid.
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