Effect of an anthralin-containing hydrocolloid dressing in psoriasis vulgaris

We investigated the effect of hydrocolloid dressings on the clearing of chronic plaque psoriasis. In comparison to a short-contact therapy with anthralin alone, following application of a hydrocolloid dressing accelerated the clearing of the plaques. This effect was significant after 3 weeks of therapy. A considerable improvement was achieved by the application of a hydrocolloid dressing containing anthralin. For this purpose anthralin in concentrations of 0.02 to 0.20 mg/cm2 was applied to the dressing immediately after it had been solved in acetone. The acetone was evaporated, and the anthralin was left on the dressing in a homogenous layer. In our study, the difference to short-contact anthralin was significant after 1, 2, 3, and 4 weeks of therapy. We conclude that this new way of anthralin application is suitable for the treatment of psoriasis and has therapeutical as well as technical advantages over a treatment with anthralin ointments.     

Saving the red baby: Successful allogeneic cord blood transplantation in Omenn syndrome

Haematopoietic stem cell transplantation is the treatment of choice for severe primary immunodeficiencies, but only has moderate prognosis in Omenn syndrome as it is complicated by highly activated Omenn T-cells resulting in delayed T-cell engraftment and a high rate of graft failure. A 6 1/2 months old patient with a previously unknown compound heterozygous defect within the RAG1 gene (R474C; R975W) underwent 8/10 HLA-matched cord blood transplantation after myeloablative conditioning. Immune reconstitution was impressive with T-, B- and NK-cells reaching the median of age-dependent reference values within twelve, four and two months respectively. With a continuous decrease of activated Omenn T-cells there was a steady increase of naive, probably thymus-derived T-cells. Polyclonal B-cell activation and hypergammaglobulinaemia disappeared with B-cell engraftment. This case emphasizes that, despite their naive status and HLA-barriers, cord blood T-cells were apparently able to achieve T-effector function resulting in the elimination of all activated Omenn T-cells.     

Video-mediastinoscopic resection of a long bronchial stump and reclosure of bronchial insufficiency after pneumonectomy

Bronchial stump insufficiency after pneumonectomy is a severe problem and there is still debate about the appropriate method (transthoracic or transsternal) for reclosure. Access through a sterile operative field for a successful redo-procedure seems to be important so an alternative to the open methods could be the video-mediastinoscopy as it allows approaching the bronchial stump via the mediastinum. Previously in 1996 Azorin performed the first mediastinoscopic reclosure by stapling an early insufficiency after left pneumonectomy. We report the first case to our knowledge of resection and reclosure in bronchial stump insufficiency via mediastinoscopy. An HIV-positive man presented with late bronchial stump insufficiency after left pneumonectomy for lung cancer. The cause was a long bronchial stump and there was no sign of tumour recurrence. Decision was made for a video-mediastinoscopy and resection and reclosure successfully performed by using an endostapler device. Postoperative bronchoscopy at six months revealed a well-healed stump and two years postoperatively the patient is doing well. The mediastinoscopic approach is a novel option in highly selected patients. It warrants minimal surgical trauma; however, one has to be prepared to convert to an open technique immediately.     

Reactivity of in vitro activated human T lymphocytes to p-phenylenediamine and related substances

Background: Patch tests to p‐phenylenediamine (PPD) and related substances often show concurrent reactions that can be attributed to separate sensitization or cross‐reactivity. Objectives: In order to understand the health risks associated with cross‐reactivity, we studied cross‐reactivity of eight chemicals in vitro by measurement of T‐cell proliferation of peripheral blood mononuclear cells (PBMC), T‐cell lines (TCL), and T‐cell clones (TCC) of subjects with a positive patch test result to PPD. Patients/Methods: We studied PBMC from 13 patients and were able to generate TCL from seven and TCC from four patients. Their proliferative responses to the chemicals were estimated. Results: Concurrent reactions to these compounds on the polyclonal and monoclonal level were found. A restricted T‐cell receptor (TCR) Vβ16‐usage was observed (5/8 clones). A detailed analysis of 34 TCL showed broad cross‐reactivity (64.7%) between PPD, p‐toluenediamine, Bandrowski’s Base, and p‐aminoazobenzene. More restricted patterns were found in 8.8%, which responded only to compounds with two or three benzene rings, whereas 26.5% of the clones reacted specifically only to one compound. Conclusion: More than 60% of the clones showed a broad cross‐reactivity pattern. Hence, clinically observed cross‐reactivity between different para‐amino compounds can be based on a TCR recognizing similar epitopes of these compounds with low specificity.     

Effects of Femoral Component Size on Proximal Tibial Strain With Anatomic Graduated Components Total Knee Arthroplasty

Survivorship in total knee arthroplasty (TKA) is multifactorial and dependent upon alignment, ligament balance, patient characteristics, and implant factors. The contribution of each factor leading to implant loosening is not well known. This study defined the effect of femoral component sizing relative to tibial size on loading patterns in the proximal tibia. Changes in strain were measured in tibiae implanted with appropriately sized metal-backed tibial components loaded with 2 sizes of femoral components. Significant increases of shear strain up to 126% were measured in peripheral regions of the tibia when loaded with a larger vs a smaller femoral component. Increased peripheral loading in the proximal tibia could predispose to a higher risk of cancellous overload and failure. Limiting stress concentrations in the periphery of the proximal tibia by considering sizing relationships between femoral and tibial components may decrease osseous strains and the likelihood of bony overload in TKA.     

Urtikaria

Urticaria is divided in acute and chronic urticaria. Chronic urticaria lasts at least six weeks. Among this symptom one can separate at least the physical urticaria, urticaria with intolerance to aspirin or food additives, autoimmune urticaria beside chronic idiopathic urticaria. In children urticaria seems not to be as often as in adults, especially with regard to chronic urticaria. A frequency of about 5% of all urticaria patients is assumed to be younger than 16 years. About 7% of these patients are suffering from cold urticaria. Major progress in the understanding of the pathophysiology of urticaria has been achieved in recent years. Most important was the recognition of anti-FcεRIα autoantibodies in about 30% of patients with chronic urticaria. The first line drug for the treatment of most cases of urticaria are the antihistamines, demonstranting, that histamine is a major inflammatory compound which mediates urticaria. The development of antihistamines of the “3rd generation” such as ceterezine, fexofenadine, or levoceterezine provides us with safe drugs in this condition in which a longterm treatment may be needed.     

Characterization of a Human Carcinosarcoma Cell Line of the Ovary Established after in Vivo Change of Histologic Differentiation

Objectives. Cell lines are valuable in vitro models for clinical and basic research. Most ovarian cancer cell lines described are serous cystadenocarcinomas or poorly differentiated adenocarcinomas. The establishment of ovarian cancer cell lines with rare histologic differentiation is especially of interest. We describe the establishment of a carcinosarcoma cell line of the ovary after in vivo selection.Methods. The cell line OV-MZ-22 was established from a solid tumor mass in the upper abdomen. At the time of establishment, the patient underwent secondary debulking and was pretreated with six cycles of cis-platinum/epirubicin/cyclophosphamide. Features of the cell line studied included morphology, ultrastructure, heterotransplantation, chromosome analysis, and analysis of intermediate filament proteins and actins by immunocytochemistry.Results. The first histologic report of the patient described a papillary cystadenocarcinoma, which changed to a carcinosarcoma with predominantly sarcomatous differentiation at secondary debulking. This cell line is aneuploid and shows no expression of the tumor-associated antigens CA-125 and CEA, but an overexpression of MDR-1, lung resistance protein, p53, and topoisomerase I and II, but not of multidrug-resistance-associated protein. The cell line did not give rise to transplant tumors in nude mice. The histologic and immunocytochemical comparison of the primary and the relapsed tumor proved evidence of an in vivo change of differentiation from predominantly papillary cystadenocarcinoma to carcinosarcoma. Morphological characteristics and intermediate filament pattern underlined the sarcomatous differentiation and origin of this cell line. The differentiation phenotype of OV-MZ-22 cells is that of smooth-muscle cells.Conclusion. The change of histologic differentiation was apparently due to a selection process caused by platinum-containing chemotherapy. The origin of the cell line and its rarity make this new line an appropriate tool for further investigation.