Search PubMed⌕ Search

Biomedical subjects

W C Marsch

Publications and source records attributed to W C Marsch.

At least 73 records · Page 4Linked to original sources

[Burns from undisclosed acids in a liquid used by temporary workers. A recent problem in occupational medicine caused by a lack of information].

HISTORY: Two temporary labourers, on piece work without sufficient prior instructions, were employed to clean a house facade. During the work, at first limited to 5-10 minutes, they sustained chemical burns from the hydrofluoric and hydrochloric acids contained in the liquid used to clean the stone. Both workers had been left uniformed about the danger or kind of the material being used, because of their short-time employment. They only sought medical help several hours later. ADMISSION FINDINGS: At the areas of contact with the cleansing liquid (hands, lower arms and thighs, in case 1; additionally at first well circumscribed and very painful areas of erythema, developing within a few hours into blisters, in case 2; also erosions in both). INVESTIGATIONS: Chemical burns by hydrofluoric acid were only elucidated as the cause 24 hours after exposure. Repeat tests (ECG, blood gas analysis, electrolyte levels) provided no evidence of deep-seated burns at the contact areas or systemic poisoning. Radiology of the hand was normal. TREATMENT AND COURSE: As there was at first no indicative history, toxic contact dermatitis was suspected and treated topically with Clobetasol-17-propionate. Once the true cause became known treatment consisted of compresses with 10% calcium gluconate solution. All lesions healed completely within 4 and 6 days, respectively. INTERPRETATION: Temporary workers are often insufficiently instructed, despite clear legal regulations. Such lack of informations increases the risk of harm to workers and makes appropriate treatment more difficult.

Administration, Topical↗

Low-dose oral etoposide monotherapy in adult Langerhans cell histiocytosis.

BACKGROUND: The purpose of this study was to test the disease-controlling effect of low-dose oral etoposide monotherapy in adult-onset multisystem Langerhans cell histiocytosis. There are no previous reports of low-dose etoposide monotherapy for this condition. OBSERVATIONS: A 27-year-old man with a 7-year history of multifocal chronic Langerhans cell histiocytosis presented with severe disabling ulcers in intertriginous areas. He had previously been treated with 2 different regimens of antitumoral chemotherapy; one had to be discontinued due to myelosuppression and the other had proved ineffective. We treated with oral etoposide monotherapy at 50 mg/d (22 mg/m2 per day) for 21 days. The treatment was repeated at 28-day intervals for a total of 6 cycles. A rapid initial response with subtotal diminution of the involved skin area was found. No adverse effects were observed. The clinical picture has remained stable during the 7 months following cessation of therapy. CONCLUSION: Low-dose oral etoposide treatment is an adequate therapeutic measure for prolonged disease control in adult-type Langerhans cell histiocytosis.

Administration, Oral↗

Serological distinction between syphilis and Lyme borreliosis.

The serological distinction of an immune response to the agent of syphilis, Treponema (T.) pallidum, and Lyme disease borreliae is difficult due to the existence of cross-reacting antibodies. In this study, the immunoblot technique is used to compare the immune response of sera from patients with syphilis or Lyme borreliosis to either T. pallidum or Borrelia (B.) burgdorferi. Patients with syphilis showed an IgG response to the 17 and 15 kDa antigens of T. pallidum, whereas sera from patients with Lyme borreliosis-especially in late stages of the disease-reacted with the 95 and 19-17 kDa antigens of B. burgdorferi. Thus, IgG antibodies against low molecular weight antigens of T. pallidum (17, 15 kDa) or B. burgdorferi (19-17 kDa) may represent useful markers for the serological diagnosis of syphilis or Lyme borreliosis.

Antibodies, Bacterial↗

Immunohistochemical characterization of the 'intimal proliferation' phenomenon in Sneddon's syndrome and essential thrombocythaemia.

Cellular changes were immunocytochemically characterized in skin vessels of five patients with idiopathic generalized racemose livedo (Sneddon's syndrome), and one patient with localized racemose livedo associated with essential thrombocythaemia. Antibodies against alpha-smooth muscle-actin, tropomyosin, desmin, vimentin, factor VIII-related antigen, human endothelial cells (CD31), human macrophages (CD68), and HLA-DR positive cells (CR3/43) were used. Conventional light microscopy showed, in all cases, intimal thickening of ascending arteries and arterioles as a result of an accumulation of cells and extracellular hyalinized material. None of the specimens showed infiltration with polymorphonuclear leucocytes or macrophages. The cells in the region of the intimal hyperplasia showed intense positive immunostaining for alpha-smooth muscle actin and tropomyosin. Staining for the intermediate filament desmin was localized to the resident smooth muscle cells of the media, whereas staining for vimentin was found in all types of cells in both the intima and media. Positive immunostaining for factor VIII-related antigen and CD31 was strictly confined to the endothelial cells lining the narrowed lumina of the vessels. No positive staining with either antibody was observed in totally occluded vessels. Cells in the subintimal space did not show reactivity for CD68 in any of the specimens, but two cases showed solitary cells with positive staining for HLA-DR in this region. There were no differences in staining pattern between Sneddon's syndrome and essential thrombocythaemia with any of the antibodies. Our results support the assumption that the 'intimal proliferation' in both diseases is caused by colonization of the subendothelial space with contractile cells of possible smooth muscle origin.(ABSTRACT TRUNCATED AT 250 WORDS)

Actins↗

Juxta-articular fibrotic nodules in Borrelia infection--ultrastructural details of therapy-induced regression.

Juxta-articular fibrotic nodules in chronic Borrelia burgdorferi infection commonly regress rapidly under antibiotic therapy. They may therefore serve as a good in vivo model for studying the development and regression of cutaneous fibrotic processes. As shown in a typical case of acrodermatitis chronica atrophicans, this spirochete-induced fibrosis in the upper subcutis of the elbow region is histologically characterized by broad hyalinized collagen tracts interspersed with prominent perivascular lymphocytes and plasma cells. These immune cells vanish completely after 5 days of antibiotic treatment, while fibroblasts discharge matrix vesicles and form elastic fibres.

Elbow↗

Carbonic anhydrase is abundant in fenestrated capillaries of cherry hemangioma.

A strong correlation has been found between carbonic anhydrase (CA) activity and fenestrations in juxtaepithelial capillaries of several tissues, including psoriatic lesions of human skin. In the present study we demonstrate that the majority of the capillaries in cherry hemangiomas are fenestrated and histochemically react CA positively. Obviously the occurrence of CA in these capillaries corresponds to the fenestrations of venous capillaries, which are numerously revealed by electron microscopy. In normal undiseased skin no capillary staining for CA was observed. Therefore in a large proportion of the capillaries of cherry hemangiomas the correlation between fenestrations and CA activity also exists. We suggest that the histochemical demonstration of CA activity might serve as a sensitive and simple marker for fenestrated capillaries in skin tissue.

Adult↗

Cutaneous fibroses induced by Borrelia burgdorferi.

Three cases of chronic infection with Borrelia burgdorferi are described. The patients presented with nodular or discoid fibrosis, partly in conjunction with acrodermatitis chronica atrophicans (ACA). Juxta-articular fibrotic nodules may develop within a few months of the onset of ACA. Nodular, discoid morphoea-like, and widespread cutaneous fibroses in chronic Borrelia infection may be provoked by trauma, surgery or electromagnetic radiation. They respond well to antibiotic therapy. These lesions offer an in vivo model for studying the evolution of immunologically induced fibrosis.

Adult↗

Increase in types IV and VI collagen in cherry haemangiomas.

The capillaries in cherry haemangiomas show perivascular hyalinized sheaths. In order to clarify the nature of this sheath material, the extracellular matrix of cherry haemangiomas from 20 normal volunteers (age range 30-64 years) was investigated using immunohistochemical and electronmicroscopical methods. Antibodies against collagen types III, IV and VI and laminin were used. Hyaluronic acid was visualized using the hyaluronic acid binding region of the cartilage proteoglycan as ligand. Electronmicroscopically, the sheaths contained multilaminated basement membrane-like material, collagen fibres 20-25 nm thick with a periodicity of 67 nm and broad-banded aggregates with a periodicity of 100 nm (zebra bodies or fibrous long-spacing fibres). Immunohistochemically, type IV collagen was stained throughout the whole sheath material. Staining for laminin was more confined to the endothelial side of the sheath. Intense staining for type III collagen and hyaluronic acid was found in the connective tissue of the subpapillary layer and between the cherry haemangioma capillaries. Much weaker staining for type III collagen and no staining for hyaluronic acid were found invariably in an area 4-10 microns thick directly around the capillaries. Both sheath material and intercapillary connective tissue of the haemangiomas showed pronounced staining for collagen type VI. Immunogold staining revealed that type VI collagen was localized to microfibrils 5-6 nm thick and to the broad-banded aggregates with 100 nm periodicity. These findings further underline the assumption that the broad-banded aggregates consist of type VI collagen.

Adult↗

Carbonic anhydrase--a marker for fenestrated capillaries in psoriasis.

A strong correlation between capillary fenestrations and the demonstration of carbonic anhydrase (CA) has previously been shown. In the present histochemical study we sought to determine whether CA could serve as a marker for fenestrated capillaries in psoriasis. In normal human skin capillary staining for CA was found only in the fenestrated capillaries of the perifollicular and periglandular plexus. In psoriatic skin lesions, however, the intrapapillary capillaries also reacted for CA. From ultrastructural investigations it is known that these capillaries are fenestrated. Our findings have shown that there is a strong correlation between fenestrated and CA-positive capillaries in normal human skin as well as in the lesional skin of psoriatics. Therefore, the demonstration of CA activity may serve as a specific and sensitive marker for fenestrated capillaries in psoriasis using an uncomplicated method, which makes it possible to detect numerous fenestrated capillaries in a single histological section.

Adult↗

Quantification of keratinolytic activity from Dermatophilus congolensis.

The bacterium Dermatophilus congolensis is the causative agent of pitted keratolysis, a skin disease. Infection occurs mainly in keratinized tissues and it is necessary for the organism to produce and excrete exoenzymes which are able to degrade keratin. We investigated the amount of keratinase liberated using Keratinazure as substrate and the fungal protease XI as standard. When compared with uninoculated samples, D. congolensis liberated significant amounts of keratinase during a 12-day incubation period with this substrate. An equivalent of 15 units of protease (keratinase) was produced by 10(7) colony-forming units of D. congolensis during a 12-day period at 37 degrees C. We consider the extracellular proteolytic activity of this bacterium to be responsible for keratinized tissues being the main sites of infection.

Actinomycetales↗

Episodic angioedema with eosinophilia: precursor lesions and relevance of histology. A case report.

A 59-year-old patient suffered from persistent angioedema-like swellings and blood eosinophilia. The disease was preceded by an erythema multiforme-like exanthema and urticarial papules. Persistent eosinophilia with exclusion of its known causes and skin biopsy helped to establish the diagnosis of the benign variant of hypereosinophilic syndrome known as 'episodic angioedema with eosinophilia'. Corticosteroid therapy was successful. The therapeutic alternatives are discussed.

Angioedema↗

[Congenital poikiloderma syndrome with early childhood blister formation (Brain syndrome) and unusual associated neurologic symptoms].

We report on an 8-year-old girl with manifestations of congenital poikiloderma during her first year of life. Macroscopically, there was reticular teleangiectasia on cheeks and thighs, generalized de- and hyperpigmentation, dry skin with pityriasiform scaling and milia as a result of former blister formation. Histologically and ultrastructurally cytoid bodies, probably of keratinocyte origin, were observed. Associated findings were leucocytopenia, hyperlipoproteinaemia, spastic ataxia and lack of teeth. There is consanguinity in the family, but 3 sisters, the parents and the ancestors were completely healthy. Because of transient blister formation on the face, upper arms and elbows we would like to classify our case as Brain syndrome.

Child↗

[HTLV-I infection: ungual T-cell lymphoma as a primary manifestation].

A 34-year-old woman presented with leathery thickening and haemorrhagic lesions of several finger- and toe-nails as first symptoms of an HTLV-I infection. Histology resembled that found in mycosis fungoides. Later signs of T cell deficiency (e.g. Pneumocystis carinii pneumonia) developed. An erythemato-papular exanthema representing T cell lymphoma with Pautrier's abscesses preceded her death 1 year later. The detection of HTLV-I antibodies helped to establish the diagnosis following initial confusion owing to elevation of the T-helper cells and the CD4/CD8 ratio.

Adult↗

[Pampiniform livedo--an acute cardinal symptom of a cutaneous cholesterol embolism].

Acute, painful, persisting, pampiniform and asymmetrical skin discolorations over the legs occurred after retrograde femoral artery catheterization in three patients suspected of having renal artery stenosis. The cause was found histologically to be embolization of cholesterol crystals to the arterioles of the corium-subcutis. Under treatment with acetylsalicylic acid the painful cutaneous changes gradually regressed. The possibility of cholesterol crystal emboli from atheromatous plaques in the aorta should be considered if the described skin changes occur, especially in the legs and with normal arterial pulsations. Proof lies in the histological picture of slit-like spaces in the arteriolar vessels at the corium-subcutis juncture, previously occupied by cholesterol crystals dissolved during fixation, and surrounding inflammatory changes with vessel wall thickening.

Acute Disease↗

Dermatological signs of nasopharyngeal linguatulosis (halzoun, Marrara syndrome)--the possible role of major basic protein.

Two hours after ingestion of improperly cooked meat a German tourist in Tunisia showed coughing, hoarseness, dysphagia, anosmia, frontal headache and epistaxis. At the same time a papular non-itching exanthema developed. The nasal discharge contained nymphs of Linguatula serrata. Histological examination of the papules revealed tissue eosinophilia and 'flame figures'. Nasopharyngeal and skin signs subsided spontaneously within 10 days. The possible role of major basic protein in the pathogenesis of nasopharyngeal linguatulosis is discussed.

Acute Disease↗