Management of erosive lichen planus with topical tacrolimus and recurrence secondary to metoprolol

Metoprolol, a widely prescribed beta-adrenergic receptor blocker, has occasionally been associated with a diversity of cutaneous reactions. We present a 79-year-old male patient with erosive lichen planus (LP) on the feet and hands who was successfully treated with topical tacrolimus. Six months after the lesions had been cured the patient received the beta-receptor blocker metoprolol for the treatment of hypertonus. Within only 2 weeks of metoprolol intake the erosive lesions on the palms and feet recurred. After discontinuation of the drug and repetitive topical treatment with tacrolimus a complete remission of the lesions could be achieved. The recurrence of erosive LP probably secondary to metoprolol and the therapeutic success of topical tacrolimus in the treatment of LP are discussed.

Severe Valproic Acid Intoxication is Associated with Atrial Tachycardia: Secondary Detoxication by Hemoperfusion

Valproic acid is an anticonvulsant drug which is associated with serious toxicity including fatal outcome in case of severe intoxication. Secondary detoxication by hemodialysis or hemoperfusion has been employed successfully in valproic acid intoxication. Cardiac arrhythmias have only been described rarely in valproic acid intoxication in humans. We report on a 15 year-old boy with severe valproic acid intoxication (valproic acid plasma level on admission: 1 150 mg/l) who presented with coma, hypernatremia and atrial tachycardia. The patient was successfully treated with hemoperfusion and intensive supportive care without implementation of a specific antiarrhythmic therapy. We conclude that patients with severe valproic acid intoxication may benefit from secondary detoxication. In addition to generally known symptoms valproic acid intoxication may also be associated with cardiac arrhythmias.

In vitro recombination cloning of entire cDNA libraries in Arabidopsis thaliana and its application to the yeast two-hybrid system

In the postgenomic era many experiments rely on the availability of transcript sequence for cloning. As these clones usually originate from cDNA libraries, the quality of these libraries is crucial. If a good library is generated it is desirable to use a versatile cloning system suitable for many different kinds of applications. The cloning systems based on in vitro recombination proves fitting for this task. However, the use of this method for shuttling entire cDNA libraries between different vectors has not yet been studied in great detail. Here we describe the construction of four cDNA libraries from different tissues of Arabidopsis thaliana, the shuttling of the libraries into expression vectors, and evaluation of this method as well as its suitability for downstream applications. Libraries were constructed from seedlings, hormone treated seedlings, flowers, developing seeds and primary leaves in the "entry vector" of the Gateway cloning system. After initial characterization of the libraries, they were shuttled into an expression vector (a yeast two-hybrid prey vector). To monitor for a size bias generally assumed to be inherent to in vitro recombination methods, the libraries were characterized before and after the transfer into the expression vector. However no significant difference could be detected. The functionality of the in vitro recombination system for the shuttling of entire libraries was then further tested by protein-protein interaction screens. The results of the library characterization and of the yeast two-hybrid screens and their implications for large-scale proteomic approaches are discussed.

[Long-term course of necrobiotic xanthogranuloma with ocular involvement]

The clinical features of necrobiotic xanthogranuloma (NX) have been presented in a series of case reports, but there are hardly any reports on the clinical long-term course of this rare and usually chronic entity. Therapeutic recommendations are mostly based on individual observations, lacking general therapeutic guidelines. To illustrate a typical chronic and progressive course of NX, we report the case of a 64-year-old woman with periorbital NX, ocular involvement and IgG paraproteinemia. Diagnosed with NX for the first time in 1993, the patient was already presented in this journal in 1995. Since then a series of therapeutic options including medication with dapsone, chlorambucil, interferon-alpha, clofazimine, melphalan, fumaric acid esters, surgical treatment and other physical therapies such as radiation, plasmapheresis, and photodynamic therapy have been applied. None of these therapeutic approaches, however, showed a satisfying long-term effect. At present the patient is undergoing cyclophosphamide-dexamethasone pulse therapy.

Detection and quantification of insoluble particles by ultrasound spectroscopy

The Ultrafood system, a custom-built diagnostic ultrasound device, is used to accurately measure the concentration of particulate matter in a fluctuating high temperature liquid system. The two main problems, of thermal expansion and thermal variation in ultrasonic outputs were tackled by multi-distance measurement and low frequency spectroscopy, respectively. The resulting techniques have application at laboratory, scale for investigation of particulate suspensions and for online process monitoring.

Das Arterial-Tortuosity-Syndrom

The arterial tortuosity syndrome is a rare congenital disorder characterized by elongation and generalized tortuosity of the major arteries including the aorta. Associated clinical features consist of excessively stretchable skin and joint laxity which is indicative of a connective tissue disorder such as Ehlers-Danlos or Cutis laxa syndrome. The gene locus of the arterial tortuosity syndrome has recently been localised on chromosome 20q13; inheritance ist autosomal recessive. - We report on a newborn with arterial tortuosity syndrome and hiatal hernia, bilateral hip dislocation, inguinal hernias and diffuse tortuosity of the great arteries including the aorta. Known gene loci involved in Ehlers-Danlos syndrome, cutis laxa syndrome and other connective tissue disorders were excluded by specific DNA markers. By homozygosity mapping with polymorphic microsatellite markers it was possible to confirm the gene locus for the ATS on chromosome 20q13. In addition to the presentation of this patient, a review of the literature is presented.

A family exhibiting arterial tortuosity syndrome displays homozygosity for markers in the arterial tortuosity locus at chromosome 20q13

Arterial tortuosity associated with hyperextensible skin and hypermobility of joints, features that are characteristics of Ehlers-Danlos syndrome (EDS), has been described in several families. An arterial tortuosity locus has recently been mapped to chromosome 20q13. Here, we report a consanguineous Kurdish family in which an affected child manifested elongation and severe tortuosity of the aorta, carotid, and other arteries. Additional clinical symptoms include loose skin, hypermobile joints, hernias, and facial features that resemble EDS individuals. To examine whether the arterial tortuosity locus was involved in this child, homozygosity analysis was performed using microsatellite markers on 20q13. The affected child was found homozygous, whereas the unaffected parents and three siblings were heterozygous. Additional typing defined the genomic interval to a 37-cm region within which the arterial tortuosity locus is located. Three functional candidate genes (B4GALT5, KCNB1, and PTGIS) were sequenced. No mutations were discovered in the coding regions of these three genes and the promoter regions of B4GALT5 and KCNB1 genes. Moreover, the B4GALT5 mRNA expression was unaltered in patient-derived lymphoblastoid cells. In the PTGIS gene promoter, the affected child was homozygous for eight variable number of tandem repeats, while parents and unaffected siblings carried six repeats.

Striped mice, Rhabdomys pumilio, and other murid rodents as hosts for immature ixodid ticks in the Eastern Cape Province

Striped mice, Rhabdomys pumilio, were trapped over a period of 17 months in the Thomas Baines Nature Reserve, and placed in cages, over water, until all the ticks they harboured had detached. The mice were then returned to the reserve. Four ixodid tick species were recovered from the mice of which the larvae and nymphs of Rhipicephalus follis and Rhipicephalus simus were the most numerous. Most larvae of R. follis detached from mice trapped from March to July, and most nymphs in March and from June to September. Most larvae of R. simus detached from mice trapped from December to March, and most nymphs from January to March and during May and June. Seven ixodid tick species were collected from striped mice, house rats, Rattus rattus, vlei rats, Otomys spp. and Praomys sp. captured in the vicinity of human dwellings or animal holding facilities in the Grahamstown district. The striped mice captured in the Thomas Baines Reserve harboured considerably larger numbers of ticks than any of the rodent species in the more urbanized localit

Kinetic electron excitation in atomic collision cascades

The kinetic excitation of electrons upon bombardment of a solid surface with energetic ions is investigated. Using a metal-insulator-metal junction, hot electrons produced by the projectile impact are detected with excitation energies well below the vacuum level. The results provide information that cannot be accessed by electron emission experiments. The observed tunneling current depends on the projectile energy and the bias voltage across the junction, opening the possibility of internal excitation spectroscopy.

Microarray analysis of gene expression in soybean roots susceptible to the soybean cyst nematode two days post invasion

Soybean root cells undergo dramatic morphological and biochemical changes during the establishment of a feeding site in a compatible interaction with the soybean cyst nematode (SCN). We constructed a cDNA microarray with approximately 1,300 cDNA inserts targeted to identify differentially expressed genes during the compatible interaction of SCN with soybean roots 2 days after infection. Three independent biological replicates were grown and inoculated with SCN, and 2 days later RNA was extracted for hybridization to microarrays and compared to noninoculated controls. Statistical analysis indicated that approximately 8% of the genes monitored were induced and more than 50% of these were genes of unknown function. Notable genes that were more highly expressed 2 days after inoculation with SCN as compared to noninoculated roots included the repetitive proline-rich glycoprotein, the stress-induced gene SAM22, ss-1,3-endoglucanase, peroxidase, and those involved in carbohydrate metabolism, plant defense, and signaling.

[Lymphadenoma of the parotid gland without sebaceous differentiation. Immunohistochemical investigations]

An encapsulated tumor measuring 8 cm was removed from the parotid gland in a 42-year-old man. The tumor had grown for about 5 years. The histopathological and immunohistochemical evaluation revealed a lymphadenoma without sebaceous differentiation of the epithelial component. The tumor consisted of exclusively solid epithelial islands and a lymphoid stroma with rare lymph follicles and abundant predominantly IgG plasma cells. The histogenesis of lymphadenomas is discussed in consideration of the differential diagnosis from Warthin's tumor and the data in the literature.

?Smouldering systemic mastocytosis?

Mastocytoses are a heterogenous group of diseases characterized by proliferation and accumulation of mast cells in the skin and other organs. They are subdivided into cutaneous mastocytoses; systemic forms, which may appear with or without skin lesions; mast cell sarcomas and extracutaneous, localized, benign mastocytomas. Systemic mastocytoses apart from the skin mainly involve bone marrow, gastrointestinal tract, bones, lymph nodes, spleen and liver. Whereas indolent forms of systemic mastocytosis are mainly treated with antihistamines, glucocorticosteroids and PUVA therapy, the more aggressive forms, including mast cell leukemia, often require cytostatic chemotherapy. A 53-year old patient with beginning "smoldering systemic mastocytosis" failed to respond to high-dose systemic glucocorticosteroids and interferon-alpha. Treatment with cladribine led to an impressive improvement of skin lesions, a significant decrease in tryptase serum levels and stabilization of bone marrow infiltrates.

Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit

OBJECTIVE

Overdoses with insulin are common, and cases of hypoglycemic coma can be fatal and cause cerebral defects. However, data published on this topic are rare, consisting mostly of case reports or reports in a small number of patients. The present investigation analyzes inquiries made to a regional poisons unit involving overdoses with insulin.

PATIENTS AND METHODS

A total of 175,890 inquiries for the years 1995-2003 (until September) were evaluated. 160 inquiries were received by telephone concerning insulin overdoses, and a standardized questionnaire was sent to the physicians asking for follow-up information. The cases were analyzed in regard to etiology, type of insulin used, concomitant substances being taken by the patient, symptoms and clinical outcome.

RESULTS

Of the 160 inquiries investigated, 53.1% of the patients were female, 43.1% male and in 3.8% the sex of the patient was unknown. The average age was 44.7 years. 89.4% involved suicidal or parasuicidal cases, 5.0% were accidental overdoses and 1.9% involved cases of criminal overdose (3.7% were for other reasons). Rapidly acting insulins (57.8%) were used more commonly than long-acting formulations (42.8%). Benzodiazepines were the most frequently ingested concomitant medication (37.5%) with ethanol 15.6%, antihypertensive drugs 12.5% and antidepressants 10.0%. Most patients presented with a delay of 2-3 hours after insulin administration (15.0%). Almost 50% of the patients presented within the first 6 hours. According to the Poisoning Severity Score, no symptoms were observed in 16.8% of the patients, minor symptoms in 36.8%, major symptoms in 25.2% and serious symptoms in 21.3%. Information concerning the clinical outcome (75 cases) showed that a full recovery occurred in most patients (94.7%), but in 2.7% there were cerebral defects and 2.7% of the patients died.

CONCLUSIONS

The etiology of overdoses with insulin was mainly deliberate self-poisoning. Physicians should take into account that long-acting insulin formulations and concomitant substances were frequently used. For overdoses with insulin, relatively high rates of serious symptoms and deaths were observed.

Endosonographic imaging of benign and malignant pheochromocytomas

Endosonography enables imaging of the adrenal glands, the mediastinum, and the epigastric retroperitoneal area. In this study, the diagnostic power of endosonography regarding the detection and localization of pheochromocytomas and the differentiation between benign and malignant lesions and their metastases and recurrences was investigated. Endosonography was performed using a Pentax FG 32 UA endosonoscope with a longitudinal 7.5-MHz sector array from the esophagus, stomach, and duodenum. A total of 22 pheochromocytomas in 11 patients were studied. All these tumors, recurrences, and metastases were histologically proven except in one single patient where pheochromocytoma had been diagnosed histologically in the past, and actual findings were obvious local recurrence and four metastases. Malignant pheochromocytoma (n = 10) tended to be larger at the time of examination than benign pheochromocytoma (n = 12; P = 0.069). No significant differences between benign and malignant pheochromocytomas regarding echogeneity and echostructure could be detected. However, hyperechoic echogeneity was seen only in benign lesions, which, however, had variable echogeneity. If confirmed by future observations, hyperechoic echogeneity may be considered to be suggestive of a benign nature. In several cases, endosonography detected small lesions that had been missed by routine diagnostic procedures and yielded helpful information for planning surgical strategy. In conclusion, endosonography is considered to be useful in early detection of pheochromocytomas, and in malignant disease of recurrence and metastases.

Kompetenznetz Hepatitis (Hep-Net)

In Germany almost 1 million people are affected by chronic viral hepatitis. Despite of the improved therapy options for the treatment of hepatitis B and C, several questions regarding epidemiology, pathophysiology and therapy are still unclear. Vaccines against hepatitis C and D viruses are still not available. Additionally, many patients and their relatives need information about infectiosity, course of the disease and therapy options. By the integration of doctors' practices and patient advocacy groups, Hep-Net aims at the educational information on the infection and tries to give access to qualified therapy strategies for all patients with an indication for therapy. After 18 months the Hep-Net Homepage already shows more than 9000 hits per day. Consultation hours via telephone, email-services and numerous activities in cooperation with the Deutsche Leberhilfe e.V. are highly frequented. In the Hep-Net study-house high-standard clinical studies with first successful results are centrally organized. Further, basic questions in the fields of epidemiology, virology and immunology are processed in cooperative research projects within the network.