Nachweis geophiler und zoophiler Dermatophyten bei Geschwistern mit Tinea capitis

Two siblings of African origin presented with multiple scaling patches and alopecia on the scalp four weeks after returning from a vacation in Eritrea. Direct KOH examination revealed fungal elements; Trichophyton mentagrophytes and Trichophyton terrestre were identified in the fungal culture. We discuss the putative pathogenic role of both microorganisms in causing disease. Although infection with Microsporum canis currently accounts for almost fifty percent of all cases of tinea capitis in Germany, other fungi have gained importance due to tourism and increasing migration.     

Inflammatory pseudotumors of the central nervous system: report of 3 cases and a literature review

Inflammatory pseudotumors (IPs), mostly benign lesions characterized by fibrotic ground tissue and polyclonal mononuclear infiltrate, may affect all organ systems. IPs originating in the central nervous system (IP-CNS) are very rare, and their distinct histopathologic features are poorly characterized. Three otherwise healthy patients (age 8, 15, and 17 years) presented with focal neurologic symptoms (seizures, n = 2; headaches, n = 1), corresponding to a left temporal, left occipital, and left frontal IP, respectively, extending from meningeal structures into brain tissue. After resection, no recurrence was observed in patient 1 during 5 years of follow-up, whereas patient 2 developed a rapidly progressive local recurrence and a second intracerebral lesion despite antiviral, immunosuppressive, antibiotic, and radiation therapy. In patient 3, who also showed local recurrences, sequential histopathologic investigations revealed transformation to a semimalignant fibrohistiocytic tumor. In this patient, anaplastic lymphoma kinase (ALK) expression was also positive, whereas it was negative in patient 1. A detailed literature analysis confirmed that most IP-CNS arise from dural/meningeal structures (n = 34). Intraparenchymatous (n = 7), mixed intraparenchymatous/meningeal (n = 4), and intraventricular lesions (n = 7) or IP extending per continuitatem from intracerebral to extracerebral sites (n = 5) were rare. The recurrence rate was 40% within 2 years in general. It was increased after incomplete resection and in female patients (multivariate Cox regression model, P < 0.02). Although rare, IP-CNS are important differential diagnoses among tumor-like intracranial lesions. Their potential risk of malignant transformation and high risk of recurrence necessitate close follow-up, especially when resection is incomplete. Prospective multicenter trials are needed to optimize classification and treatment of this rare inflammatory lesion.     

Sonography and scintigraphy in the diagnosis of cystadenolymphomas (warthin tumor)

BACKGROUND: Is scintigraphy in the preoperative diagnosis of cystadenolymphomas dispensable? PATIENTS AND METHODS: In this prospective study 35 patients with tumors of the parotid gland were examined sonographically and scintigraphycally and the results were compared with the histological findings. RESULTS: By means of sonography 88 % (22/25) of the cystadenolymphomas were correctly diagnosed and by means of scintigraphy 80 % (20/25). CONCLUSIONS: Sonography is recommendable as the first-line diagnostic procedure in cystadenolymphomas because it is without radiation load, the free choice of the echographic plane, and it can be repeated as often as desired. Scintigraphy adds in selected cases, as in elder patients, additional informations. The combination of sonography and scintigraphy confirms the presence of cystadenolymphoma and allows the surgeon to make a decision and to avoid surgery especially in high-risk patients.     

Consensus statement: Expedition Inspiration fund for breast cancer research meeting 2002

We conducted a hospital-based case-control study to evaluate the association between the XbaI and PvuII restriction fragment length polymorphisms (RFLPs) in intron 1 of the estrogen receptor (ER) gene and breast cancer risk. The study population consisted of 205 histologically confirmed incident breast cancer cases and 205 age-matched controls with no present and previous history of cancer. The PvuII genotype distribution did not show any difference between cases and controls, but the adjusted odds ratio (OR) for the XbaI X allele containing genotypes was 0.4 (95% CI: 0.3–0.6) compared with the xx genotype. The decrease in the OR appeared to be more attributable to the postmenopausal women; the ORs were 0.3 (95% CI: 0.1–0.5) and 0.5 (95% CI: 0.3–0.9) for postmenopausal and premenopausal women, respectively. Our results therefore suggest that the ER XbaI polymorphism modifies individual susceptibility to breast cancer in Korean women.     

The significance of complement in proliferative vitreoretinopathy

Complement is the principal effector arm of antibody-mediated allergic response and plays a central role in the pathogenesis of many immunologic disorders. The possible pathophysiologic importance of complement was examined in the development of proliferative vitreoretinopathy (PVR). Vitreous aspirates from patients with idiopathic PVR (n = 21) and traumatic PVR (n = 15) were examined for total vitreal protein (TVP) and complement components C3, C3d, C4, and C1q-fixed immunoglobulins using enzyme-linked immunosorbent assay (ELISA), sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and western blotting. The TVP, C3 components, and factor C4 were elevated significantly in diseased vitreous. The C3-TVP and C4-TVP ratios showed no difference between traumatic and idiopathic PVR. A C4 index to estimate the rate of intraocular C4 synthesis had a mean value of 3.2 (n = 15). The increased relative amount of C3d reflected complement activation in diseased vitreous. The negative values in normal human serum and plasma and in patient plasma samples (n = 15) indicated a local reaction in the eye. The authors found C1q-fixed immunoglobulin G; this may be the cause of complement activation by the classic pathway. These findings support the opinion that the cause of PVR may be based partly on an autoimmune reaction against ocular structures.     

Effect of methylxanthines on periodic respiration and acid gastroesophageal reflux in newborn infants

The treatment of neonatal apnea and bradycardia with methylated xanthines--theophylline and caffeine--is generally accepted. Besides the desired effects of these drugs they induce a wide range of side effects including relaxation of smooth muscles and increased gastric secretion. The aims of this study were, at first to investigate the coincidence of periodic breathing (PA) and acid gastro-esophageal reflux (GER) in neonates (n = 15) without therapy; at second to examine the influence of the consecutive medication with theophylline and caffeine on these parameters in patients (n = 10) with recurrent episodes of bradycardia and apnea. A 24 h esophageal pH-monitoring and 24 h cardiorespirography were performed simultaneously under standarized conditions. In the 15 neonates studied a weak correlation was found between the time spent breathing periodically and the duration of GER; the overlap of PB and GER was minimal. Theophylline and caffeine medication resulted in a marked reduction of PB which was more pronounced than it could be expected from maturation. The total time of a 24 h esophageal pH-monitoring was subdivided in an early postprandial time (FPP: first two hours after the beginning of a meal) and a late postprandial time (SPP: remaining time until the following meal). An increased duration of acid GER was observed during the SPP under therapy with theophylline and even more distinct with caffeine treatment.     

Differential effects of a new dibenzo-epine neuroleptic compared with haloperidol. Results of an open and crossover study

Fluperlapine (NB-106-689) was tested on 26 schizophrenic patients in an open and crossover study. In addition to its good antipsychotic effect, it also alleviated the apathic and depressive syndromes. Six patients who had shown only slight or no improvement after 4 weeks of haloperidol therapy responded positively to fluperlapine. The alleviation of the anergic syndrome was especially impressive. The therapeutic response of the depressive-apathic syndromes could represent an important extension of pharmacotherapy for schizophrenia. The virtual lack of extrapyramidal motor side effects with fluperlapine supports an intensification of the search for other nonclassic dibenzo-epine neuroleptics.     

Pars plana vitrectomy and silicone oil injection in proliferative diabetic retinopathy

A retrospective study is reported on 106 eyes with proliferative diabetic retinopathy, treated by vitrectomy and silicone oil injection. Indications were traction detachment in 91 eyes and nonclearing rebleeding in 15 eyes; 31 eyes had previously had vitrectomy. Anatomical success was obtained at the end surgery in 91 eyes, and after a minimum follow-up of 6 months in 68 eyes (64%). Functional results were as follows: satisfactory visual acuity (0.5–0.05) in 23 eyes (22%), ambulatory vision (0.03-CF) in 14 eyes (13%), HM-LP in 54 eyes (51%), and NLP in 15 eyes (14%). The functional results are limited by recurrent detachments due to characteristic reproliferations under the silicone bubble or by ischemic diabetic angiopathy in the attached retina. A positive effect of silicone oil is demonstrated in the reduction of preexisting or postoperatively new iris neovascularization and in preventing postoperative rebleeding.This study was supported by the Retinovit Foundation. Presented in part at the 1986 meeting of the Club Jules Gonin in Copenhagen, Denmark     

Perforating eye injuries with multiple intraocular foreign bodies following military maneuver accidents

Nine patients sustained massive ocular injuries mostly bilateral, caused by practice ammunition fragments during military maneuvers. The injuries consisted of severe contusion and perforation damage to the cornea, traumatic cataract, vitreous hemorrhage, and multiple small intraocular foreign bodies frequently impacting on or penetrating the retina. Extraction of the foreign bodies was difficult, usually because they could not be localized preoperatively, because of optical problems due to corneal opacifications and frequent hemorrhages, and because of a lack of posterior vitreous detachment. Nevertheless, in the 15 eyes which underwent secondary surgery travel vision (1/35 to 0.2) was achieved in three and good visual acuity (0.3 to 1.0) in eight. Only four eyes ended up with practical blindness (LP to hand movements) due to retinal traction detachments with proliferative vitreoretinopathy.