[Serodiagnosis and treatment of syphilis--important points of view].
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Biomedical subjects
Publications and source records attributed to A Luger.
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Investigations on the purine-salvage-pathway in erythrocytes of 3 patients with psoriasis and of 3 healthy control persons revealed equivocal differences. The transfer of 14C-adenine to adenosine-monophosphat as well as the uptake of 14C-guanine is markedly increased and the incorporation of 14C-hypoxanthine deviates in psoriatics from the controls. A correlation between these findings and the clinical course could not be observed. The paper presents first results of a study concerning the synthesis of nucleotides in the course of the reutilisation of purines within erythrocytes of psoriatic patients.
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An improved method for precise separation of 19-S-IgM from other immunoglobulines reveals the reappearance of antitreponemal 19-S-IgM-antibodies after reinfection in five patients. The IgM-FTA-ABS-test with non-separated full-serum was non-reactive in all cases due to competitive inhibition. The new assay apparently permits a clear differentiation between reinfection and non-specific increase of titers in lipoidal antigen tests. Treatment failures can be distinguished from reinfections in cases where this method can continuously be applied.
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Sources of error in the detection of specific IgM-antibodies against Treponema pallidum could be overcome by the introduction of a new method for precise separation of immunoglobulins. The 19-S-IgM-FTA-ABS-test apparently permits a correct diagnosis of syphilitic reinfection. This method is not only specific but also earlier reactive than the VDRL-test. The short-time persistence of 19 S-IgM production after treatment and its renewed appearance enables for the first time a differentiation between treatment failure and reinfection.
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Recent developments in syphilis serology are set down. The new specific tests for treponema pallidum are described. Reactivity in different stages of the disease including congenital and neurosyphilis is discussed. An outline is given of the possibilities of the IgM-FTA-ABS and 19 S IgM-FTA-ABS tests. Syphilis serology today requires only 3 tests: a screening procedure, where the specific AMHA-TP is the method of choice, FTA-ABS test should be used for confirmation, and the quantitative VDRL in order to follow up the effectiveness of treatment.
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A patient is reported who developed five plasmacytomas over a four-year period and developed a pleural mesothelioma 12 years later. The relationship of these two entities is discussed and the question of a common environmental carcinogen is raised.
The term "precancerous" needs a new definition since it includes still malignant diseases like Morbus Paget of the nipple, Morbus Bowen and Erythroplasie Queyrat. The degree of malignancy of these disorders is analyzed. Precancerous conditions in the sense of benignant disorders which necessarily develop into malignant tumors are Melanosis circumscripta praeblastomatosa Dubreuilh and actinic keratoses. Potential precanceroses may be X-ray-atrophy, Leukoplakia and oral papillomatosis. Some actinic, chemic and cytostatic cancerogens are mentioned. Reference is made to the diagnosis, differential diagnosis, prognosis and treatment of precancerous skin lesions. The problem of potential malignancy of nevi is considered in detail. Prevention of cancer needs regular careful clinical control of skin and mucous membranes at least after the 50th year of life.
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During a retrospective study of 100 patients who underwent renal biopsy because of pregnancy complicated by hypertension, we found 19 patients whom proteinuria exceeded 5.0 Gm. per 24 hours and an additional eight patients in whom excretion ranged between 3.5 and 5 Gm. per day. Of these 27 patients, 23 had the kidney lesion of pre-eclampsia, and three of them had superimposed hypertensive changes in the vasculature. The remaining four had other renal diseases. We located and re-examined 10 of the 23 pre-eclamptic women, 12 to 104 (mean, 36) months after delivery. Serum creatinine levels were normal in all but one, who was discovered to have polycystic kidney disease. During the same time period, we located the records of six women who had heavy proteinuria during gestation but were normotensive. Thus, at our institution, pre-eclampsia is the most common cause of the nephrotic syndrome in pregnancy. The frequency of nephrotic proteinuria in pre-eclampsia appears higher than previously suspected, but, despite this fact, recovery was complete in most instances.
Observations made on fluorescent treponemal antibody absorption (FTA-ABS) immunoglobulin M (IgM) titres in patients with untreated early syphilis showed non-reactive or weakly reactive results in patients with primary (one of five cases) and secondary (two of 16 cases) lesions. In patients with primary (19.5%) and secondary (15%) syphilis sera remained reactive with increased titres for more than one year after treatment. The respective figures in the results of the Venereal Disease Research Laboratory (VDRL) test were zero in primary and 20% in secondary syphilis. The non-reactive FTA-ABS IgM results may possibly be explained by competitive inhibition of IgM by immunoglobulin G (IgG). The persistence of reactivity in a comparable percentage has been observed by other investigators (Grin et al., 1974; Wilkinson and Rodin, 1976). The current results therefore suggest that FTA-ABS IgM titres are less reliable for assessing the effect of treatment than the course of the VDRL titres. The phenomenon of a decrease in FTA-ABS IgM titres soon after treatment with a later rise before final non-reactivity is a matter for further investigation.
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