[Requirements for mycological diagnostics in accordance with the guideline of the German Medical Association for quality assurance of medical laboratory tests]

The ability of recognizing various clinical manifestations of mucocutaneous mycosis, making a diagnosis, and establishing a treatment is part of a dermatologist's daily routine. However, due to the fact that clinical manifestations, laboratory diagnostics, and treatment are performed in one hand, laboratory findings are properly classified and interpreted. Since new binding guidelines of the German Medical Association on quality assurance measures in medical laboratory testing came into force, there is much concern among dermatologists of how to comply with these new regulations. It is the intention of the authors to help our readers to implement these new rules in order to make sure that mycological diagnostics continue to be part of a dermatologist's professional work.

Influence of skin cleansing preparation acidity on skin surface properties

Synopsis Two long-term trials were conducted each over eight weeks to compare the effect of the regular application of skin cleansing preparations of pH 5.5 and pH 8.5 and pH 5.5 and pH 7.0 respectively on the surface pH, roughness and transepidermal water loss (TEWL) of normal human forehead and forearm skin. Both trials were based on a cross-over design: five healthy volunteers started with a pH 5.5 preparation and switched to the other after four weeks, five additional volunteers used the preparations in the opposite order. While the skin surface pH was markedly lower in those individuals using the pH 5.5 preparation at each examination, as compared to those using the pH 8.5 or pH 7.0 preparation, no such difference could be established with respect to skin roughness and TEWL. Hence the skin irritancy of a cleansing preparation does not seem to be linked to its pH within the pH ranges tested.

MALDI-TOF MS imaging of controlled release implants

MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) imaging is used to characterize novel lipid implants allowing for controlled drug delivery. Importantly, this innovative technique provides crucial information on the inner structure of the implants before and after exposure to the release medium and does not require the addition of marker substances. Implants were prepared by extrusion at room temperature. Thus, in contrast to hot-melt extruded systems, the risks of drug inactivation and solid state transformations of the lipid matrix former are reduced. Hydrogenated/hardened soybean oil and glyceryl tristearate were studied as lipids and propranolol hydrochloride and theophylline as drugs, exhibiting significantly different solubility in water. The implants were also characterized by optical microscopy, differential scanning calorimetry, water uptake and lipid erosion studies, mathematical modeling as well as in vitro drug release measurements. Importantly, broad spectra of drug release patterns with release periods ranging from a few days up to several months could easily be provided when varying the initial drug content and type of lipid, irrespective of the type of drug. The diameter of the implants can be as small as 1mm, facilitating injection. MALDI-TOF MS imaging revealed homogeneous macroscopic drug distributions within the systems, but steep drug concentration gradients in radial and axial direction at the lower micrometer level, indicating drug- and lipid-rich domains. As the implants do not significantly swell, local irritation upon administration due to mechanical stress can be expected to be limited. Good agreement between experimentally measured and theoretically calculated drug release kinetics revealed that diffusional mass transport plays a major role for the control of drug release from this type of advanced drug delivery systems.

The Adsorption of Ethene on Pd(111) and Ordered Sn/Pd(111) Surface Alloys

The adsorption of ethene (C2H4) has been studied on Pd(111) and ordered Sn/Pd(111) surface alloys using temperature programmed desorption (TPD), ultraviolet photoelectron spectroscopy (UPS), high-resolution electron energy loss spectroscopy (HREELS), and low energy electron diffraction (LEED). Two surface alloys were prepared by thermal treatment of Sn-films, which were vapor deposited on Pd(111) at room temperature. Depending on the preparation conditions, surface alloys giving a p(2×2) or a (√3×√3)R30° LEED pattern were produced. Below 250 K ethene adsorbs on pure Pd(111) in an undissociated – but substantially distorted – form relative to the molecular structure in the gas phase: HREELS suggests an adsorption in the di-σ bonded state. A π-bonded ethene species was, however, found to coexist with this strongly rehybridized form, probably as a result of hydrogen coadsorbed from the residual gas. TPD and annealing experiments followed by UPS and HREELS indicated that most of the adsorbed ethene desorbs reversibly in the temperature range between 150 K and 350 K, while a small amount dehydrogenates. After adsorption at room temperature, ethylidyne (≡CCH3) has been identified as the most important species. Alloying Pd(111) with Sn results in a decreasing ethene-substrate interaction with increasing Sn-content in the topmost layer of the substrate. Only π-bonded ethene was formed on both surface alloys and decomposition reactions were suppressed.

Onychomycosis

The guideline on onychomycosis, as passed by the responsible German medical societies, is presented in the present study.

Tinea capitis: ringworm of the scalp

The guideline tinea capitis, as passed by three German medical societies, is presented in the present study.

Toxicity and Antimicrobial Activity of a Hydrocolloid Dressing Containing Silver Particles in an ex vivo Model of Cutaneous Infection

In the present study we examined the effects of two hydrocolloid wound dressings (conventional silver-free Comfeel, silver-incorporating Contreet-H) on uninfected and Candida albicans- or methicillin-resistant Staphylococcus aureus-infected reconstituted human epithelium (RHE). The morphological alterations of the keratinocytes caused by infection and by treatment were analysed with light and electron microscopy. As a measure of epithelial cell damage the release of lactate dehydrogenase from epithelial cells into the surrounding medium was monitored. Application of Contreet-H or Comfeel to uninfected RHE induced no major morphological effects on epithelial cells. Both wound dressings reduced the growth of micro-organisms. Specific alterations of the infected epithelium (vacuoles, spongiosis, oedema, detachment of keratinocytes) and invasion of the epithelium were significantly reduced only by treatment with Contreet-H. At the ultrastructural level release of silver by Contreet-H and superior antimicrobial efficacy could be verified. In summary, treatment with both wound dressings reduced the number of pathogens, with the silver-based wound dressing providing a more effective antimicrobial activity. This resulted in a strong decrease of pathogen-specific alterations of the infected epithelium. We present evidence that delivering silver to infected keratinocytes in a moist healing environment improves the benefit/risk ratio as compared to silver-free wound dressings.

Risk management: extreme honesty may be the best policy

This paper reviews a humanistic risk management policy that includes early injury review, steadfast maintenance of the relationship between the hospital and the patient, proactive full disclosure to patients who have been injured because of accidents or medical negligence, and fair compensation for injuries. The financial consequences of this type of policy are not yet known; however, one Veterans Affairs medical center, which has been using humanistic risk management since 1987, has had encouragingly moderate liability payments. The Department of Veterans Affairs now requires such a policy for all of its facilities; therefore, comprehensive experience may be only a few years away.

Effects of the human immunodeficiency virus (HIV) proteinase inhibitors saquinavir and indinavir on in vitro activities of secreted aspartyl proteinases of Candida albicans isolates from HIV-infected patients

The effects of therapeutically relevant concentrations of the human immunodeficiency virus (HIV) proteinase inhibitors saquinavir and indinavir on the in vitro proteinase activity of Candida albicans were investigated with isolates from HIV-infected and uninfected patients with oral candidiasis. After exposure to the HIV proteinase inhibitors, proteinase activity was significantly reduced in a dose-dependent manner. These inhibitory effects, which were similar to that of pepstatin A, and the reduced virulence phenotype in experimental candidiasis after application of saquinavir indicate the usefulness of these HIV proteinase inhibitors as potential anticandidal agents.

PROFILER: a tool for automatic searching of internally maintained databases

A new application program, the BIOINFORMATICS PROFILER, is described which simplifies the analysis of new genome sequence information appearing on a daily basis. Control tasks are defined through an intuitive graphical user interface and are executed at user defined nightly intervals. Electronic mail is sent to indicate that search results have been found. All task output is presented to users in the form of hypertext (HTML), allowing easy browsing. Currently supported tasks include BLAST and FastA sequence searching, keyword based searching of network news articles and WAIS databases, examination of GenBank sequence entries using regular expressions and boolean operations and protein sequence motif searching.

Influence of nifedipine on the metabolism of gingival fibroblasts

Calcium antagonists are the gold standard in the therapy of coronary heart disease and hypertension. The prototype of these drugs is nifedipine which, as well as its therapeutic effects on the cells of the cardiovascular system, also has unpleasant side effects on other organ systems. One side effect can be a missive hyperplasia of the gingiva, the reason for which are unclear. In vitro experiments were designed to elucidate the influence of nifedipine on the growth of human gingival fibroblasts in short and long term (72 hours, 6 weeks) cell culture. The following cellular parameters were determined quantitatively: cell proliferation (cell count, [3H]thymidine incorporation), protein synthesis ([3H]glucosamine incorporation) and viability (release of lactate dehydrogenase). A significant increase in cell proliferation (up to 1 microgram/ml nifedipine) was observed in the short-term experiments (72 hours, 0.001-10 micrograms/ml nifedipine), no other parameters were altered or were even depressed at higher concentrations. A significant increase in the cell proliferation and a decrease in the proteoglycan synthesis was found in the long term experiments (6 weeks, 1 microgram/ml nifedipine). Our results indicate that nifedipine has a direct effect on the cell proliferation of the gingival fibroblast in cell culture. The effect of nifedipine on the gingival fibroblasts are therefore similar to those observed earlier by the widely used immunosuppressant drug cyclosporin A on human gingival fibroblast in culture.

Dermatophytes on the feet of HIV-infected patients: frequency, species distribution, localization and antimicrobial susceptibility

Skin scrapings from the toe clefts, soles and nail plates of 138 HIV-infected patients at various stages were examined for the presence of dermatophytes using both microscopy and culture. Dermatophytes, in particular Trichophyton rubrum, could be grown in 58 cases (42%). Although cultures were more often positive in late stages of disease, there was no close correlation with the clinical stage or the T4/T8 ratio. Susceptibility to itraconazole, but not to other antimycotics, was correlated with the immune status (P < 0.05). Pedal dermatophyte infection does not seem to be a major problem in HIV infection.

Comparison by means of a computer-supported device of the enlarging characteristics of two different instruments

Numerous studies report different results when testing endodontic instruments with similar and/or different research protocols. However, objective studies that could eliminate the factors inherent to the operator have not yet been developed. Simulated root canals in clear casting resin were used as models. The Canal Master U and Flexogate were tested by using a double exposure photographic technique. A computer-aided device capable of reproducing three-dimensional enlarging movements and irrigation of the simulated canals was developed. The enlarging movements were programmed according to the step-back and step-down techniques. The enlarging of simulated root canals with this device proved to be constant and reproducible. Standard deviations were kept low and were dependent on the degree of canal curvature. The enlarged simulated root canals showed that both instruments could be kept centered in the path of the root canal. Results showed only a few significant differences between the effective material removed and a theoretical ideal amount of removed material.

[Mercury concentration in the mouth mucosa of patients with amalgam fillings]

Mercury concentrations were measured in specimens of oral mucosa taken during oral surgery from 90 patients (53 men, 37 women, mean age 42 +/- 16 years); 30 of the patients had no amalgam fillings. All the mucosal specimens extended for at least 2-3 mm from the epithelium of the gingival margin and were clinically and radiologically normal. Thirteen patients without metallic fillings of any kind had mercury concentrations of 118.4 +/- 83.7 ng/g tissue, and in 17 patients with precious metal fillings but no amalgam the mean mercury concentrations were 144 +/- 290 ng/g tissue. Seventeen patients with 1-3 amalgam fillings had an average of 1975 +/- 4300 ng/g tissue and in 26 patients with 3-6 amalgam fillings the average concentration was 1158 +/- 2500 ng/g tissue. In 17 patients with more than six amalgam fillings the mean mercury concentration was 2302 +/- 5600 ng/g tissue. Although these results demonstrate a considerable degree of transfer of mercury from the amalgam fillings to the oral mucosa, it had not resulted in any clinically detectable mucosal lesions.

Efficacy of different irrigation methods and concentrations of root canal irrigation solutions on bacteria in the root canal

The effectiveness of two different root canal irrigating solutions, each in two different concentrations or formulations, with two different irrigation methods was compared in vitro by means of bacterial survival determinations. 75 human root canals were enlarged, sterilized and inoculated with a mixed culture of Escherichia coli and Streptococcus mutans. After inoculation, the root canals were irrigated either manually or with an ultrasonic device for equal times (20s) with the same amount (5 ml) of sodium hypochlorite (1% and 2%), Fokalhydran I and Fokalhydran II. Sodium hypochlorite (1% and 2%) was used in a 1:100 dilution. Fokalhydran I and II were used in a 1:10 dilution. In the sodium hypochlorite group, the 1% concentration applied with a syringe proved to be most effective against Escherichia coli and Streptococcus mutans. The least effective concentration and application method against both bacteria species was obtained with 2% NaOCL and ultrasonics. Against Escherichia coli and Streptococcus mutans, a significantly lower effectiveness was found with 2% NaOCL applied with ultrasonics with respect to the rest of the sodium hypochlorite group. Fokalhydran I was significantly better than Fokalhydran II against Escherichia coli. However, no significant differences could be seen against Streptococcus mutans within this group.

[Modulation of glycosaminoglycan- and collagen synthesis of human gingival fibroblasts by progesterone]

Hormonal changes occuring during pregnancy are known to induce periodontal changes and may therefore influence preexisting periodontal diseases negatively. Since glycosaminoglycans (GAG) and collagen are the principal constituents of the matrix, the influence of progesterone on their synthesis was chosen as an assay system. Confluent human gingival fibroblast cultures grown under standard conditions were preincubated with progesterone levels ranging from 0.05 to 0.5 microgram/ml for 48h before GAG synthesis was assayed by incorporation of 14C-glucosamine. The GAG fraction was detemined by ion-exchange-chromatography and fractionated precipitation. Collagen-synthesis was monitored by 14C-proline-incorporation. Progesterone concentrations corresponding to those seen in the third trimenon of pregnancy were able to lower GAG-synthesis; the synthesis of all GAG-species was affected in a similar way. Collagen synthesis was only affected by unphysiologicaly high hormone doses. The observed clinical changes may therefore be due to the influence of progesterone on GAG synthesis.

[The effects of herbal agents on dental plaque and sulcus bleeding index]

This study was designed to examine the efficacy of plant-derived active substances in a combined application of toothpaste and mouth rinse on dental plaque and sulcus bleeding index and the pH values of the saliva. 50 healthy students of dentistry without periodontal diseases took part in this study. Over a period of 4 weeks half of the group used herbs, while the other half used a placebo preparation. The data of the oral examination were always obtained at 12 a.m., with the last food intake at least 1 hour before. The results revealed a significant reduction of plaque accumulation and bleeding signs under herbal extracts in contrast to the placebo preparation. The salivary pH values were shifted to the alkaline range in the herbal extract group whereas the placebo product showed the opposite effect. Our data demonstrate the usefulness of herbal extracts as an adjunct in the treatment of periodontal disease and in a routine preventive regimen.

[Influence of saliva components on periodontal disease in insulin-dependent diabetics]

In diabetic patients an increased incidence of periodontal disease has been demonstrated. This study was to elucidate the influence of saliva constituents on periodontal alterations. 31 insulin-dependent type-I diabetics and a control group were submitted to oral examination. During daytime salivary samples were collected at regular intervals for analysis of glucose, sodium, potassium, calcium and the pH values. Additional information on relevant blood values and organic complications were obtained from the diabetic group. The results revealed a significant correlation between the degree of diabetes control and periodontal disease. The saliva concentrations of glucose and potassium were significantly elevated as against the controls. However, no correlation was found between the saliva components and periodontal disease.

Influence of high glucose concentrations on glycosaminoglycan and collagen synthesis in cultured human gingival fibroblasts

Human gingival fibroblasts were used to study the effects of increasing concentrations of glucose on protein, collagen and glycosaminoglycan (GAG) synthesis. GAG-synthesis was measured as incorporation of 3H-glucosamine into pronase-resistant macromolecules and collagen synthesis was evaluated by 3H-proline incorporation into collagenase-sensitive protein. Incubation of the fibroblasts with glucose concentration ranging from 5 to 50 mM resulted in a dose-dependent reduction of collagen synthesis; labeled collagen in the culture medium was reduced to 60% of the control incubation (5mM glucose) when incubated with 50 mM glucose for 72 h. Cell-associated radioactivity was decreased to 80% under the same conditions. Although 3H-glycosamine incorporation into GAGs was reduced by increasing glucose concentrations (5 to 20 mM), protein synthesis and cell number were not influenced under the same conditions, as was also the case with distribution of macromolecules in the GAG fractions. The importance of these in vitro results to the incidence of chronic inflammatory periodontal disease in diabetic patients is discussed.

[Influence of conservative periodontal treatment on degree of gingival inflammation]

Assuming that conservative periodontal therapy is essential and important for the further surgical therapy, it was the purpose of this present study to investigate the effect of conservative periodontal therapy of gingiva. 50 patients were examined. Significant reductions of plaque index (42%) and bleeding index (29%) were obtained and statistically significant.

[Periodontal alterations in patients with non-insulin dependent diabetes]

The periodontal status and the DMF status of 51 non-insulin dependent patients treated on an inpatient basis for diabetes (Type II) were assessed and correlated with the specific clinical findings and parameters of diabetes. Oral hygiene (as determined by means of the plaque index) as well as caries frequency showed no correlation with Type II diabetes. A significant correlation, however, was found according to the Trend Test between the loss of attachment and the increase in the blood glucose levels. Consequently, a direct correlation between diabetes and the periodontal condition can be assumed.

[Comparative studies on periodontal indexes with particular to the Periotest method]

40 patients from both gender were examined to determine if there is a correlation between periodontal indices and periotest values. As a result we were able to show that the pocket depth correlates with the periotest values for all tooth groups. On the other hand SBI correlates with the periotest values only for the premolars in upper and the front in lower jaw.

Bullous pemphigoid antigen concentration in normal human skin in relation to body area and age

The amount of bullous pemphigoid antigen (BPA) in normal human skin on different areas of the body and in bodies of different ages was determined by making endpoint titer estimations using the indirect immunofluorescence technique. Two sera with bullous pemphigoid antibodies were tested with 36 specimens of normal human skin from six cadavers. The greatest expression of BPA was found in plantar sites, whereas the lowest endpoint titers were seen in flexural arm biopsy specimens. Age-dependent differences in BPA expression were detected as well. The oldest individuals tested produced the highest endpoint titers in contrast to the lowest endpoint titers in the youngest. This study suggests that the amount of BPA depends not only on the body region where the biopsy specimen is taken but also on the age of the donor. This is important to know in connection with indirect immunofluorescence assays for BP antibodies on human skin.

[Fasciitis eosinophilica--transition to an unusual scleroderma (scleroderma-fasciitis)]

Eosionophilic fasciitis (EF) was observed in a girl who suddenly developed indurations of the limbs accompanied by hypergammaglobulinaemia and peripheral eosinophilia. The deep fascia was impressively thickened and infiltrated with numerous inflammatory cells showing focal accumulations of eosinophils. The disease was progressive in spite of application of corticosteroids, and within three years, symmetrical sclerodermatous lesions developed on the face and trunk, going along with a severe sclerodactyly without Raynaud's phenomenon, as well as contractures of the upper and lower limbs causing complete disability. Visceral involvement was slight (decreased motility of the esophagus and restriction of pulmonal function); slight calcium deposits were disclosed at the soft tissue of the ankles; and nuclear antibodies of the speckled type appeared in a titer up to 320. The fascia was still the most involved tissue, but there was no peripheral or tissue eosinophilia. EF seems to be a special variant within the broad spectrum of scleroderma; and although it usually has a benign course, it may change into an unclassified variety of scleroderma and lead to severe disability.