[Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]

BACKGROUND

Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP).

METHODS

To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012.

RESULTS

In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments.

CONCLUSIONS

Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

Dermocosmetics for dry skin: a new role for botanical extracts

Dry skin is associated with a disturbed skin barrier and reduced formation of epidermal proteins and lipids. During recent years, skin-barrier-reinforcing properties of some botanical compounds have been described. Searching the PubMed database revealed 9 botanical extracts that specifically improve skin barrier and/or promote keratinocyte differentiation in vivo after topical application. The topical application of Aloe vera (leaf gel), Betula alba (birch bark extract), Helianthus annuus (sunflower oleodistillate), Hypericum perforatum (St. John's wort extract), Lithospermum erythrorhizon (root extract), Piptadenia colubrina (angico-branco extract) and Simarouba amara (bitter wood extract) increased skin hydration, reduced the transepidermal water loss, or promoted keratinocyte differentiation in humans in vivo. The topical application of Rubia cordifolia root extract and rose oil obtained from Rosa spp. flowers stimulated keratinocyte differentiation in mouse models. The underlying mechanisms of these effects are discussed. It is concluded that some botanical compounds display skin-barrier-reinforcing properties that may be used in dermocosmetics for dry skin. However, more investigations on the mode of action and more vehicle-controlled studies are required.

Nicotinic acid/niacinamide and the skin

Nicotinic acid (also generally known as niacin) and niacinamide (also known as nicotinamide) are similarly effective as a vitamin because they can be converted into each other within the organism. The blanket term vitamin B(3) is used for both. Niacinamide is a component of important coenzymes involved in hydrogen transfer. Here, the two codehydrogenases, nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) are of central importance. Topical application of niacinamide has a stabilizing effect on epidermal barrier function, seen as a reduction in transepidermal water loss and an improvement in the moisture content of the horny layer. Niacinamide leads to an increase in protein synthesis (e.g. keratin), has a stimulating effect on ceramide synthesis, speeds up the differentiation of keratinocytes, and raises intracellular NADP levels. In ageing skin, topical application of niacinamide improves the surface structure, smoothes out wrinkles and inhibits photocarcinogenesis. It is possible to demonstrate anti-inflammatory effects in acne, rosacea and nitrogen mustard-induced irritation. Because of its verifiable beneficial effects, niacinamide would be a suitable component in cosmetic products for use in disorders of epidermal barrier function, for ageing skin, for improving pigmentary disorders and for use on skin prone to acne.

O/W emulsions compromise the stratum corneum barrier and improve drug penetration

BACKGROUND

W/O emulsions improve the stratum corneum barrier, while microemulsions tend to compromise it. We, therefore, were interested to explore the effects of O/W emulsions on the stratum corneum barrier.

METHODS

Aqueous Cream BP 2001, Clioquinol Cream BP 1999 without clioquinol, Nonionic Hydrophilic Cream DAB 2001 without glycerol, Hydrophilic Skin Emulsion Base NRF S. 25., point of time 2001, without glycerol, and Base Cream DAC were tested versus untreated controls in 29 healthy volunteers for 7 days. Outcome measures included transepidermal water loss (TEWL), skin redness (chromametry a*-value) and erythrocyte circulation in the subpapillary vessels (laser Doppler). Barrier compromise was subsequently explored by performing the hydrocortisone blanching test using Hydrocortisone Cream 0.5% NRF 11.36. (outcome measure: a*-value) in 15 subjects and the sodium lauryl sulfate (SLS) irritation test (outcome measures: TEWL, a*-value, laser Doppler) in 14 subjects.

RESULTS

Pretreatment with the test emulsions produced increases in TEWL (statistically significant for all test emulsions), a*-value (statistically significant for Aqueous Cream BP 2001 and Base Cream DAC), and laser Doppler value (statistically significant for all emulsions except Base Cream DAC). Hydrocortisone penetration was statistically significantly increased with all test emulsions versus untreated contols. SLS irritation was mostly statistically significantly increased versus untreated controls when analyzing the study endpoint-baseline difference.

CONCLUSIONS

O/W emulsions may compromise the stratum corneum barrier and improve drug penetration.

[Effects of emulsions on the stratum corneum barrier and hydration]

The appearance of the skin depends greatly on the hydration of the stratum corneum which is regulated by water binding substances of the corneocytes and also by the quality of the stratum corneum lipids. Furthermore these lipids are responsible for the barrier function. In patients with atopic dermatitis, the water binding capacity and the barrier function of the stratum corneum are reduced even in clinically healthy skin areas. Emollients can damage the stratum corneum and lead to desiccation and a disturbance of the barrier. This effect is a result of an increased permeability of the barrier lipids and direct damage to the keratinocytes and corneocytes. The degree of damage of the barrier caused by emollients in dermatological vehicles has not been sufficiently investigated. As suggested by hypothetical considerations, such an effect is not expected and cannot be demonstrated in water-in-oil-emulsions. Oil-in-water-emulsions without glycerol as well as lipophilic and hydrophilic microemulsions do damage the barrier function. Both types of microemulsions additionally lead to a dehydration of the stratum corneum. The damaging effect of oil-in-water-emulsions can be reduced by the addition of glycerol and urea.

Do urea/ammonium lactate combinations achieve better skin protection and hydration than either component alone?

Twenty subjects with healthy skin were treated with the following formulations for two weeks: drug-free W/O vehicle, 5% ammonium lactate (CAS 52003-58-4) in W/O vehicle, 5% urea (CAS 57-13-6) in W/O vehicle, 3% ammonium lactate + 3% urea in W/O vehicle, 5% ammonium lactate + 5% urea in W/O vehicle. These formulations were applied in randomized order to 6 test areas on the forearms; one area was left untreated. Repetitive washings were additionally performed in the second treatment week. TEWL, stratum corneum water content (corneometry-determined electrical capacitance), and cutaneous blood flow (laser Doppler) were measured at baseline, day 7, and day 14. 5% urea and both ammonium lactate/urea combinations produced significant stratum corneum hydration and improved stratum corneum barrier function; there were no significant differences between these three treatments.

[Clinical effect of salicylic acid and high dose urea applied according to the standardized New German Formulary]

OBJECTIVE

To determine whether salicylic acid and high dose urea in five different NRF (New German Formulary) formulations have an effect on stratum corneum.

METHODS

20 healthy volunteers had their stratum corneum blacked with silver nitrate and a photographic developer, and a chromameter (a*-value) was used to determine the amount of discoloration produced by the study products and the drug free vehicles after 24 hours semiocclusive application and 24 hours later. The change in fingerpad ridge width produced by the study formulations and drugfree vehicles was determined at the same time, using the Hikoscope Dermatoscope after 30 and 35 minutes' use under an occlusive dressing. The results obtained with the two methods were correlated.

RESULTS

All study formulations were effective. There were differences in the time course of the effects on the stratum corneum. The fingerpad ridge width method is not a measure of keratolytic activity because there were no significant correlations between the results obtained with the two methods. Also, 40% urea was keratolytic in the silver nitrate test, but had no effect of fingerpad ridge width.

CONCLUSIONS

All NRF study formulations were effective in the stratum corneum. The fingerpad ridge width method is not a measure of keratolytic activity but rather of an other unknown effect of salicylic acid.

Do shake lotions, zinc oil and polyethylene glycol gels produce dehydration or moisturization?

We carried out three studies to evaluate the effects of white zinc shake lotion (Zinkschüttelmixtur DAC), zinc oil ( Zinköl NRF 11.20), Lotio Cordes, PEG ointment (Polyethylenglykolsalbe DAB) and PEG paste on nonmoisturized and moisturized skin. The aim of the study was a clear indication for these vehicles in the clinical practice. Studies 1 and 2 were performed on 20 healthy volunteers. Study 1 was carried out on nonmoisturized skin, while test areas in study 2 were treated with the study products after 1-hour moisturization with hydrophilic aqueous ointment (hydrophile wasserhaltige Salbe DAB), covered with a semiocclusive film dressing. Study 3, carried out on 10 subjects, differed from study 2 by a longer follow-up period. The water content of the horny layer before and after application of the different vehicles was estimated by the capacitance measurement (Corneometer CM 820) and the conductance measurement (Skikon). The glycerol-containing zinc shake lotion and both PEG gels (with or without zinc oxide) produced hydration under the conditions of study 1 and 2. Zinc oil and moisturizer-free Lotio Cordes had little impact on stratum corneum hydration under the conditions of studies 1-3. Therefore, zinc shake lotion and the two PEG ointments can be used in the treatment of dry atopic skin, but not in overhydrated skin, e.g. in intertriginous regions. Zinc oil and Lotio Cordes can be used in overhydrated skin but not in dry skin, for the missing water-binding capacity in the horny layer. On the other hand an effective dehydrating effect cannot be expected.

Opposing effects of glycerol on the protective function of the horny layer against irritants and on the penetration of hexyl nicotinate

BACKGROUND

It is known that glycerol in an oil-in-water emulsion has a protective effect against irritating substances.

OBJECTIVE

To answer the question: is the protection effect of glycerol based on a regenerative process?

METHODS

Upon irritation by either tape stripping or acetone treatment, we applied glycerol to the skin surface under an occlusive dressing to create transepidermal water movement. As a control we used water under the occlusive dressing on the contralateral forearm. After 5 h we compared the barrier function using biological tests.

RESULTS

A significant improvement of the protective barrier function was observed in the glycerol-treated areas, as shown by the alkali resistance and by the irritant effect of dimethyl sulfoxide (DMSO) as well as sodium lauryl sulfate. Surprisingly, at the same time penetration of hexyl nicotinate improved on the glycerol-treated areas. A direct physicochemical protection effect on the surface of the skin was ruled out in additional studies using NaOH and DMSO.

CONCLUSIONS

Under the given conditions glycerol leads to a more rapid reconstitution of the protective skin barrier and initiates a regenerative skin protection. In contrast to that, it is acting as a penetration enhancer.

Effect of topically applied dexpanthenol on epidermal barrier function and stratum corneum hydration. Results of a human in vivo study

In a randomized, double-blind, placebo-controlled study the effect of topical dexpanthenol (CAS 81-13-0) formulated in two different lipophilic vehicles on epidermal barrier function in vivo was carried out. Seven days' treatment with dexpanthenol improved stratum corneum hydration and reduced transepidermal water loss. Active treatment was statistically different from the vehicle control on both measures. Our results suggest that topical dexpanthenol formulated in either lipophilic vehicle stabilizes the skin barrier function.

Phosphorylation status of the SCR homeodomain determines its functional activity: essential role for protein phosphatase 2A,B'

Sex combs reduced (SCR) is a Drosophila Hox protein that determines the identity of the labial and prothoracic segments. In search of factors that might associate with SCR to control its activity and/or specificity, we performed a yeast two-hybrid screen. A Drosophila homologue of the regulatory subunit (B'/PR61) of serine-threonine protein phosphatase 2A (dPP2A,B') specifically interacted with the SCR homeodomain. The N-terminal arm within the SCR homeodomain was shown to be a target of phosphorylation/dephosphorylation by cAMP-dependent protein kinase A and protein phosphatase 2A, respectively. In vivo analyses revealed that mutant forms of SCR mimicking constitutively dephosphorylated or phosphorylated states of the homeodomain were active or inactive, respectively. Inactivity of the phosphorylated mimic form was attributed to impaired DNA binding. Specific ablation of dPP2A,B' gene activity by double-stranded RNA-mediated genetic interference resulted in embryos without salivary glands, an SCR null phenotype. Our data demonstrate an essential role for Drosophila PP2A,B' in positively modulating SCR function.

Tolerance profile of retinol, retinaldehyde and retinoic acid under maximized and long-term clinical conditions

BACKGROUND

Topical retinoic acid (RA) causes irritation of the skin. To prevent this side effect, natural precursors of RA have been proposed. The aim of the present study was to compare the local tolerance profiles of retinol (ROL), retinaldehyde (RAL) and RA.

METHODS

ROL, RAL and RA were studied using repeated insult patch tests for 14 days (n = 6). Similarly, RAL and RA were assessed in long-term clinical use for 44 weeks (n = 355). Clinical scoring on irritation, measurement of transepidermal water loss (barrier function) and laser Doppler blood flow perfusion units (irritation) were performed.

RESULTS

Under maximized conditions, an equally low irritation potential for ROL and RAL and a more pronounced irritant effect with RA could be demonstrated clinically (p < 0.05 in the intergroup analysis). Furthermore, RAL and RA induced more scaling than ROL (p < 0.05), and ROL and RA tended to induce more burning/pruritus than RAL (nonsignificant). The TEWL values were low with ROL and high with RAL and RA (nonsignificant, intergroup analysis). The laser Doppler measurements confirmed pro-irritating effects of RA and the nonirritating effects of ROL and RAL (p = 0. 001, intergroup analysis). The long-term clinical study showed that the study population developed a high frequency of erythema (44% of the population), scaling (35%) and burning/pruritus (29%) with RA in the first 4 weeks of treatment, whereas these 3 parameters were significantly less frequent with RAL (p < 0.0001 in the intergroup analysis).

CONCLUSION

The natural retinoids ROL and RAL do have a good tolerance profile, in contrast with the irritating potential of RA.

Antibacterial efficacy of benzoyl peroxide in phospholipid liposomes. A vehicle-controlled, comparative study in patients with papulopustular acne

BACKGROUND

Literature reports indicate that phospholipid liposomes facilitate the accumulation of active agents in the infundibulum.

OBJECTIVE

The study hypothesis of an improved antibacterial efficacy of benzoyl peroxide (BPO) in phospholipid liposomes was tested in comparison with a commercial and a pharmacopoeial BPO preparation.

METHODS

The infundibular bacterial samples were obtained with the Permabond technique from 20 acne patients who had been treated with the test substances (vehicle-controlled) for 2 weeks twice per day in a single-blinded, comparative study on the upper back.

RESULTS

A significant antibacterial effect in the infundibula (Propionibacteria and Micrococcaceae, both: p < 0.001) for a BPO phospholipid liposome formulation could be demonstrated. In comparison to the other significantly efficacious BPO formulations which were also tested (commercial product and pharmacopoeial formulation), the BPO phospholipid liposome formulation showed a significantly greater antibacterial efficacy for Propionibacteria and Micrococcaceae (both: p < 0.01).

CONCLUSION

A BPO formulation in phospholipid liposomes may represent an improvement of the conventional external BPO treatment of acne.

Effect of topically applied evening primrose oil on epidermal barrier function in atopic dermatitis as a function of vehicle

The aim of this study was to establish the effect on barrier function in atopic dermatitis of topical evening primrose oil in an amphiphilic and a stable water-in-oil emulsion. The studies were vehicle-controlled in two populations of 20 atopic subjects. Barrier function was assessed in terms of transepidermal water loss and stratum corneum hydration after a 4-week treatment period and a 1-week treatment-free period. A barrier function test with sodium lauryl sulphate (SLS) and nicotinic acid ester was also carried out. Evening primrose oil proved to have a stabilising effect on the stratum corneum barrier, but this was apparent only with the water-in-oil emulsion, not the amphiphilic emulsion. The choice of vehicle is therefore an extremely important factor in the efficacy of topically applied evening primrose oil.

Predictive washing test for evaluation of individual eczema risk

It was the aim of our studies to estimate predictively the individual eczema risk for persons due to repetitive contact with washing-active substances, by a barrier function test on clinically healthy skin over 2 weeks. Within the scope of the study 3 groups with different atopy scores were compared. As washing solutions, 0.1 m SLS and a slightly acid soap-free washing emulsion were used in comparison to tap water. Prior to the 1st washing procedure, on days 3, 5, 8, 10, and 12, the transepidermal water loss, the horny layer moisture, and the skin blood flow were measured as parameters of barrier function, as well as the inflammatory reaction. The results prove that the atopy score has only limited validity as a predictive method for the acceptance of washing-active substances. The repetitive washing test, however, seems to be more adequate for evaluating the individual barrier function as well as the eczema risk. Irritation by a washing procedure may be greatly influenced by choice of the washing solution.

Influence of vitamin E acetate on stratum corneum hydration

The influence of vitamin E (tocopherol, CAS 10191-41-0) on stratum corneum hydration was tested in O/W and W/O emulsions. Additionally, the O/W emulsion was used in an in vivo/in vitro method to gravimetrically obtain evidence concerning the water-binding capacity of the stratum corneum. In the W/O emulsion, 2.5%, 5%, and 7.5% vitamin E were compared. With both types of emulsions, vitamin E increased the stratum corneum hydration statistically significantly (p = 0.0002). In addition, we could provide evidence of an enhanced water-binding capacity after treatment with vitamin E (p = 0.05). For the hydrating effect of vitamin E. its concentration is of importance. The optimum concentration turned out to be 5%.

[Modification of stratum corneum quality by glycerin-containing external ointments]

The effects of glycerol are discussed in detail. Glycerol can lead to a transition of crystalline lipid structures within the horny layer lipids into liquid crystalline states. Especially if applied in oil/water-emulsions it improves, the hydration of the horny layers better than urea. In addition, if facilitates the dissolution of desmosomes within the superior layers of the horny layer enhancing desquamation. Furthermore, by using glycerol, the mechanical properties of the skin can be influenced; long term used leads to increased elasticity. The roughness of the horny layer is reduced, which can be explained by the abrasive and/or the hydrating effect. Glycerol used in o/w-emulsions also protects against the influence of tensides or noxious lipophilic agents. Presumably a flux from the base of the epidermis towards its surface triggers the regeneration of the barrier. Finally, glycerol can lead--similarly to urea--to an improvement in active agent penetration, as has been proven for hexylnicotinate.

Squid Pax-6 and eye development

Pax-6 in vertebrates and its homolog eyeless in Drosophila are known to be essential for eye development. Here we investigate the role of Pax-6 in eye development in another major systematic group, molluscs. We demonstrate that alternatively spliced RNAs derived from a single Pax-6 gene in the squid (Loligo opalescens) are expressed in the embryonic eye, olfactory organ, brain, and arms. Despite significant sequence differences between squid Pax-6 and Drosophila eyeless in the region outside the paired- and homeodomains, squid Pax-6 is able to induce the formation of ectopic eyes in Drosophila. Our results support the idea that Pax-6 related genes are necessary for eye and olfactory system formation throughout the animal kingdom.

Damage to the skin by repetitive washing

Damage to the skin following the repeated use of 2 different wash solutions was investigated. Stratum corneum capacitative resistance, stratum corneum lipids, transepidermal water loss, skin surface pH, laser Doppler flow and skin reddening were determined. All skin function parameters already showed a marked change after a single wash (e.g., the median of TEWL values increased by more than 0.5 g/m2 h). Repetitive washing for 1 week led to a further deterioration of TEWL and corneometry values (e.g., TEWL increased for about 2.9 g/m2 h after repetitive washing with sodium lauryl sulfate). The rate of skin function regeneration after repetitive washing was unaltered compared to regeneration after a single wash. The surfactants used showed quantitatively differing effects on corneometry, TEWL and laser Doppler flow (e.g., after repetitive washing with Geliderm, the median of TEWL values increased only up to 1.55 g/m2 h). However, damage arising from repetitive washing could not be completely prevented by the selection of a mild surfactant. Skin function regeneration showed no difference with the 2 surfactants used.

Determination of the nuclear magnetic resonance solution structure of an Antennapedia homeodomain-DNA complex

The nuclear magnetic resonance (NMR) solution structure of a complex formed by the mutant Antennapedia homeodomain with Cys39 replaced by Ser, Antp(C39S), and a 14 base-pair DNA duplex containing the BS2 operator sequence was determined using uniform 13C and 15N-labeling of the protein. Two-dimensional nuclear Overhauser enhancement spectroscopy ([1H,1H]NOESY) with 15N(omega 2)-half-filter and 13C(omega 1, omega 2)-double-half-filter, and three-dimensional heteronuclear-correlated [1H,1H]NOESY yielded a total of 855 intramolecular NOE upper distance constraints in the homeodomain, 151 upper distance constraints within the DNA duplex, and 39 intermolecular protein-DNA upper distance constraints. These data were used as the input for the structure calculation with simulated annealing followed by molecular dynamics in a water bath and energy refinement. A group of 16 conformers was thus generated which represent the solution structure of the Antp(C39S) homeodomain-DNA complex. The new structure determination confirms the salient features reported previously from a preliminary investigation of the same complex, in particular the location of the recognition helix in the major groove with the turn of the helix-turn-helix motif outside the contact area with the DNA, and the N-terminal arm of the homeodomain contacting the minor groove of the DNA. In addition, distinct amino acid side-chain-DNA contacts could be identified, and evidence was found that the invariant residue Asn51 (and possibly also Gln50) is in a slow dynamic equilibrium between two or several different DNA contact sites. The molecular dynamics calculations in a water bath yielded structures with hydration water molecules in the protein-DNA interface, which coincides with direct NMR observations of hydration waters. In the Appendix the experimental data obtained with the Antp(C39S) homeodomain-DNA complex and the techniques used for the structure calculation are evaluated using a simulated input data set derived from the X-ray crystal structure of a DNA complex with a homologous homeodomain. This study indicates that a nearly complete set of NOE upper distance constraints for the Antp(C39S) homeodomain and the protein-DNA interface was presently obtained. It further shows that the structure calculation used here yields a precise reproduction of the crystal structure from the simulated input data, and also results in hydration of the protein-DNA interface in the recalculated complex.

Nuclear magnetic resonance spectroscopy of a DNA complex with the uniformly 13C-labeled Antennapedia homeodomain and structure determination of the DNA-bound homeodomain

A 1:1 complex formed by the mutant Antennapedia(C39S) homeodomain and a 14 base-pair DNA duplex (molecular weight approximately 18,000) was prepared in which the protein was uniformly 13C-labeled. Using two-dimensional nuclear Overhauser enhancement (NOE) spectroscopy with 13C(omega 1, omega 2)-double-half-filter and three-dimensional 13C-correlated NOE spectroscopy, nearly complete sequence-specific resonance assignments were obtained for both the protein and the DNA in the complex. On this basis conformational constraints needed for a three-dimensional structure determination were collected. Using 855 intramolecular distance constraints as input, the structure of the DNA-bound Antp(C39S) homeodomain was calculated with the program DIANA, followed by restrained energy minimization with the program OPAL. A group of 20 conformers characterizes a well-defined structure for residues 8 to 56, with an average of 0.5 A of the pairwise root-mean-square deviations calculated for the backbone atoms of the individual conformers relative to the mean coordinates. The quality of the resulting structure is comparable to the one for the free protein, and the global fold of the free Antp(C39S) homeodomain was found to be conserved in the DNA complex. The structure of the DNA-bound protein was the starting point for the subsequent structure determination of the complete Antp(C39S) homeodomain-DNA complex in solution.

Enhancement of the penetration of dithranol and increase of effect of dithranol on the skin by liposomes

An assessment was made in healthy skin of dithranol erythema caused by a 10-min occlusive application of 0.5% dithranol (CAS 1143-38-0) in liposomal gel (Natipide II) with and without the addition of 3% salicylic acid, and of 0.5% dithranol in vaseline and in a removable standard ointment base, both with 3% salicylic acid. Both liposomal preparations led to a significant potentiation of the dithranol erythema. The results indicate a strong promotion of the penetration of dithranol by the liposomal gel.

Structure determination of the Antp (C39----S) homeodomain from nuclear magnetic resonance data in solution using a novel strategy for the structure calculation with the programs DIANA, CALIBA, HABAS and GLOMSA

The structure of a mutant Antennapedia homeodomain, Antp(C39----S), from Drosophila melanogaster was determined using a set of new programs introduced in the accompanying paper. An input dataset of 957 distance constraints and 171 dihedral angle constraints was collected using two-dimensional n.m.r. experiments with the 15N-labeled protein. The resulting high quality structure for Antp(C39----S), with an average root-mean-square deviation of 0.53 A between the backbone atoms of residues 7 to 59 in 20 energy-refined distance geometry structures and the mean structure, is nearly identical to the previously reported structure of the wild-type Antp homeodomain. The only significant difference is in the connection between helices III and IV, which was found to be less kinked than was indicated by the structure determination for Antp. The main emphasis of the presentation in this paper is on a detailed account of the practical use of a novel strategy for the computation of nuclear magnetic resonance structures of proteins with the combined use of the programs DIANA, CALIBA, HABAS and GLOMSA.

[The effect of selected output parameters on the flushing results of MOET (Multiple Ovulation and Embryo Transfer)]

Superovulation responses from 299 Hessian donors were used to analyse the influence of selected traits and ovulation-parameters. The effects of the age of life were similar to those of other authors. Fat yield (phenotypic) showed a small positive influence on the number of collected embryos. Genetic value of the sire had no effect and using sperm of one or two bulls made no difference. A prediction of an individual MOET-response by a selected parameter is not possible.

[Comparative study of the effect of various antiseptics and ozone gas on pathogens of ulcus cruris]

The germicidal influence of various antiseptics on the bacterial and fungal flora of leg ulcers was studied in vitro. Best effects were achieved by the triphenylmethane dyes brilliant green and methylrosaniline chloride. Chloramine and povidone iodine yielded average results, whereas the germicidal effects of potassium permanganate and eosin were not satisfactory. On the other hand, treatment with ozone resulted in sufficient inactivation of germs--with the only exceptions of Serratia and Klebsiella species.

Results of a combination treatment with natamycin and butylscopolamine in cases of intestinal Candida colonization

The findings described show that Candida species can be found in the feces of approximately half a population of nonselected test persons and in the mouths of approximately a third. Intestinal Candida colonization was found in most of these persons after one feces examination, and in practically all of them after a second examination. 10 d of therapy with 400 mg natamycin per day in sugar-coated tablet form and 40 mg natamycin in the form of tablets for sucking produced a negative fungus test for the feces in only 20% of the cases. Although a combination of this therapy with 3 x 10 mg butylscopolamine per day improved short-term results significantly, the long-term results were hardly influenced at all. Typifying results according to the Warnock method showed that we are dealing with recurrences in practically all cases and not with new infections. Minimal inhibition concentrations (MIC) of natamycin showed no marked changes as a consequence of the natamycin treatment.

[Panniculitis with liquefaction--a special manifestation of Pfeiffer-Weber-Christian panniculitis]

A case of nodular panniculitis with liquefaction in a 58-year-old woman patient is reported. It seems that Pfeiffer-Weber-Christian disease and nodular panniculitis with liquefaction are varying expressions of the same disease entity. The relationship to cases reported in the literature is discussed.

[Familial circumscribed plantar keratosis with sensorineural hearing loss and sporadic CHILD syndrome]

The authors report a case of siblings in whom circumscribed plantar keratoderma developed during early childhood. The keratotic areas increased with age and also affected the dorsal aspects of the digital joints. In addition, a markedly progressive disturbance in sound perception occurred in both children from age 4 onwards. This observation confirms the concept proposed by Blanchet-Bardon et al. that focal palmoplantar keratoderma with sensorineural hearing loss constitutes a distinct entity. In addition, the younger sister was affected with the CHILD syndrome. She suffered from linear ichthyosiform nevus with ipsilateral ectrodactyly. The simultaneous occurrence of the two syndromes is probably purely coincidental.

[Cardiospermum--a new phytogenic drug in dermatology?]

In a double blind study on persons with healthy skin, we tested the efficacy of cardiospermum ointment against the ointment base only. There were no significant differences between placebo and active substance regarding clinical evaluation, light reflection photometry, and transepidermal water loss. By means of doppler laser flowmetry, we found a decrease in corial blood supply after 16 hours' application of cardiospermum, which suggests a possible antiphlogistic effect.

[Practical aspects of local steroid treatment]

Dermatocorticosteroids, the extent of whose effects show extraordinary differences, are principally applied in the case of skin inflammations and hyperproliferative skin diseases. Side effects, especially a dermally atrophizing effect, but also the provocation of rosacea, rosacea-like dermatitis and steroid acne, make it necessary to apply a treatment with as few side-effects as possible. Here in particular, therapy in steps and, to a lesser extent, interval therapy have proved themselves as being valuable. It is best to restrict oneself to a few dermatocorticosteroids, contained as far as possible in the same hypoallergenic base at varying concentrations. Thus the risk of sensitization and the different penetration levels depending on localization and dermatosis are taken into full account. A combined therapy with antibiotics is not indicated as a rule, and a combination with antimycotics should be restricted to a short period of time only.

Hox-7, a mouse homeobox gene with a novel pattern of expression during embryogenesis

A new mouse Hox locus, Hox-7, is defined on chromosome 5 by a gene homologous to the Drosophila gene msh, which contains a homeobox sequence distantly related to that of Antennapedia. By in situ hybridization, expression of Hox-7 is detected in the neural fold of embryos, and also in cephalic neural crest. In addition, expression takes place in the developing valves of the embryonic heart. Mandibular and hyoid arches are strongly labelled, expression becoming restricted to the most distal part of mouth and face processes as development proceeds. Intense labelling is also observed in developing limb buds, in the distal region which has been shown to be essential for limb morphogenesis. The pronounced accumulation and regional localization of Hox-7 transcripts in mandibular and limb processes point to a specific morphogenetic role for this mouse homeobox gene.

Secondary structure determination for the Antennapedia homeodomain by nuclear magnetic resonance and evidence for a helix-turn-helix motif

The homeodomain encoded by the Antennapedia (Antp) gene of Drosophila was studied in aqueous solution by nuclear magnetic resonance (NMR). Sequence-specific resonance assignments have been obtained for the complete polypeptide chain of 68 amino acid residues. The secondary structure determined from nuclear Overhauser effects (NOE) and information about slowly exchanging amide protons includes three helical segments consisting of the residues 10-21, 28-38 and 42-52, respectively. Combination of the presently available NMR data with computer modeling provided preliminary evidence for the presence of a helix-turn-helix motif in the homeodomain. Near the turn, this supersecondary structure appears to be very similar to the DNA binding site in the 434 and P22 c2 repressors, but both helices in the homeodomain include 2-3 additional residues when compared with these prokaryotic DNA-binding proteins.

[IgM kappa immunocytoma in IgM-kappa monoclonal gammopathy]

A case of monoclonal gammopathy of the IgM kappa class is reported, in which a large number of reddish-brown, non-itching papules, reaching at maximum the size of peas and aligned in a follicular arrangement, had been seen to an unchanged extent on the left upper thigh for 6 years. Both histologically and immunohistologically, a B-cell lymphoma releasing kappa-type IgM was demonstrated. The clinical picture obtained was different from that of the few other cases reported in the literature, which have always involved either large-surface infiltrates or much larger nodes, either solitary or irregularly arranged.