Skin lesions,malaise, and heart failure in a renal transplant recipient

A male Caucasian patient developed nodular erythematous skin lesions, malaise, and clinical signs of progressive heart failure 4 months after renal transplantation. Bronchoscopy with bronchoalveolar lavage performed for a small infiltrate seen on a computed tomography scan revealed Trypanosoma, which had at this point not been suspected as a cause. Parasitemia was present, and reactivation rather than transmission of Chagas' disease was established by performing polymerase chain reaction and serology in the donor and recipient. Treatment with benznidazole and allopurinol successfully reduced parasitemia, but the clinical course was fatal owing to progression of severe myocarditis. The patient had never lived in an endemic area, but had an extensive travel history in South America. The last visit was more than 5 years before transplantation. In non‐endemic countries (United States, Europe), reactivation after transplantation has only been very rarely reported. Given the rising numbers of transplantations in patients with a migration background and extensive travel histories, specific screening procedures have to be considered.     

Skin allergies

Zum Thema Allergien k?nnen sich am Hautorgan nicht nur mit den unterschiedlichsten Krankheitsbildern manifestieren, auch k?nnen sie durch unterschiedliche allergische Reaktionstypen ausgel?st werden. Der hiermit vorliegende Beitrag beschreibt die pathogenetischen Vorg?nge und die Klassifikation der zu Grunde liegenden allergischen Reaktionen. Zus?tzlich wird die klinische Symptomatik, Diagnostik und Therapie der h?ufigsten allergisch bedingten Hauterkrankungen von der Urtikaria, dem Ekzem, über die Purpura bis zum Arzneimittelekzem dargestellt.     

Skin cancer

The current status, clinic, causes and prevention strategies of malignant tumours of the skin are described. Dermatologists, physicians and health professionals have made tremendous efforts to improve the public education and early detection of these tumours especially during the last decade. Further campaigns and continual medical education are demanded to continue this improvement for patients and public health system.     

Skin Biomes

The cutaneous microbiome has been investigated broadly in recent years and some traditional perspectives are beginning to change. A diverse microbiome exists on human skin and has a potential to influence pathogenic microbes and modulate the course of skin disorders, e.g. atopic dermatitis. In addition to the known dysfunctions in barrier function of the skin and immunologic disturbances, evidence is rising that frequent skin disorders, e.g. atopic dermatitis, might be connected to a dysbiosis of the microbial community and changes in the skin microbiome. As a future perspective, examining the skin microbiome could be seen as a potential new diagnostic and therapeutic target in inflammatory skin disorders.     

Measurements of immature platelets with haematology analysers are of limited value to separate immune thrombocytopenia from bone marrow failure

Detection of immature platelets in the circulation may help to dissect thrombocytopenia due to platelet destruction from bone marrow failure (BMF ). We prospectively tested the predictive value of immature platelets, measured as immature platelet fraction (IPF ) on the XE‐5000 (Sysmex, Kobe, Japan) or percentage of reticulated platelets (rPT ) on the CD Sapphire (Abbott Diagnostics, Santa Clara, CA, USA) to separate immune thrombocytopenia (ITP ) from BMF (leukaemia, myelodysplastic syndrome, aplastic anaemia). We analysed 58 samples of patients with BMF , 47 samples of patients with ITP and 97 controls. Median rPT (CD Sapphire) was increased to 9·0% in ITP and to 10·9% in BMF , compared to 1·9% in controls. Median IPF (XE‐5000) was 16·2% in ITP , 10·2% in BMF and 2·5% in controls. We found an inverse correlation between high fractions of immature platelets and low platelet counts in thrombocytopenic samples regardless of the diagnosis. In conclusion, we observed a broad overlap of immature platelets between ITP and BMF , which may be caused by an accelerated release of immature platelets in any thrombocytopenic state and decreased production in many patients with ITP . Despite this, IPF (XE‐5000) had some power to discriminate ITP from BMF , whereas rPT (CD Sapphire) was of no predictive value.     

Skin Treatments and Dermatological Procedures to Promote Youthful Skin

The skin, the largest organ of the body, is the organ in which changes associated with aging are most visible. With increasing frequency, patients are requesting information and treatments that improve the appearance of their skin. Corresponding to this trend, there is an increasing number of products and methods available that claim to aid this pursuit. First, a change of the patient''s lifestyle (eg, sun behavior, nicotine abuse, and nutrition) must take place. Only then may other methods be used. This article reflects on the following topics: topical retinoids, peels, botulinum neurotoxin, soft tissue fillers, lasers, topical and systemic endocrinological therapies, and phytohormones. A thorough knowledge of the properties (benefits, limitations, and complications) of the expanding array of possibilities for rejuvenation of the skin is essential for any physician treating patients with cosmetic complaints.     

Advances in understanding the pathogenesis of familial myeloproliferative neoplasms

Myeloproliferative neoplasms (MPNs) are generally acquired as a result of a somatic stem cell mutation leading to clonal expansion of myeloid precursors. In addition to sporadic cases, familial MPN occurs when one or several MPN affect different relatives of the same family. MPN driver mutations (JAK2, CALR, MPL) are somatically acquired also in familial cases, so a genetic predisposition to acquire one of the MPN driver mutations would be inherited, even though the causative germline mutations underlying familial MPN remain largely unknown. Recently some germline variants [ATG2B and GSKIP duplication, RBBP6 mutations, SH2B3 (LNK) mutations], which can cause familial MPN, have been reported but these mutations are rare and do not explain most familial cases. Patients with familial MPN show the same clinical features and suffer the same complications as those with sporadic disease. This review aims to offer up‐to‐date information regarding the genetics of familial MPN.     

Validation of Modelflow Estimates of Cardiac Output in Hemodialysis Patients

Volume‐clamp technology (e.g. Finometer) has become a popular method of collecting continuous, non‐invasive, hemodynamic information during hemodialysis. There is minimal data validating the technique in this patient group. A gold standard cardiac output measurement can be obtained using ultrasound dilution in patients with arterio‐venous fistulae. Continuous cardiac output was measured in 124 hemodialysis sessions in 27 patients using a volume‐clamp device (Finometer PRO). Ultrasound dilution measurement was first taken at baseline (Transonic HD03), then used to calibrate the Finometer. Ultrasound dilution measurement was repeated 2 h into hemodialysis to assess drift following calibration. Pearson’s correlation and Bland–Altman statistics, modified for repeated measures, were used to assess agreement between methods. Linear mixed models were constructed to identify factors that could explain session‐level and patient‐level variation in agreement. For baseline cardiac output before calibration, agreement between volume‐clamp and ultrasound dilution measurements was poor, at 25 ± 75% (correlation 0.26, P < 0.001). There was significant variation in agreement between patients, with age, peripheral vascular disease and hemodialysis vintage contributing to poorer agreement. For cardiac output 2 h after calibration, agreement was ?5.2 ± 57.5% (correlation 0.6, P < 0.001). Dynamic changes in blood pressure and fluid balance during hemodialysis resulted in greater drift over time after calibration. There was a large error, both random and systematic, in volume‐clamp estimates of absolute, pre‐calibration cardiac output in this prevalent hemodialysis population. There was minimal bias and reasonable correlation for cardiac output 2 h post‐calibration, but limits of agreement remained too wide to meet current clinical standards.