[Annular skin lesions refractory to therapy].
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Adult↗
Biomedical subjects
D Krahl
Publications and source records attributed to D Krahl.
Panhypopituitarism in a patient with breast cancer.
BACKGROUND: Malaise and fatigue are common symptoms of advanced malignant disease. Nevertheless, a specific cause--requiring specified treatment--for this symptom should be ruled out. We report on a patient with a complex endocrine dysfunction that developed due to a tiny metastasis of a breast carcinoma in the pituitary stalk. CASE REPORT: A 46- year-old woman presented with general ill feeling 3 years after operation for a breast carcinoma. She was diagnosed to have hepatic and peritoneal metastases and malignant pleural effusion. For the application of chemotherapy, an i.v.-port system in the right brachiocephalic vein was inserted. In the postoperative period, an emergency situation developed due to demasked cortisol deficiency and hypernatremia. Careful laboratory investigations revealed hypofunction of the anterior lobe of the pituitary gland and diabetes insipidus centralis. By MRI imaging of the parasellar region, a 4 x 5 mm metastatic lesion in the pituitary stalk was found--notable only in knowledge of the clinical diagnosis. The patient's condition and quality of life improved markedly with hormone replacement therapy. CONCLUSION: Metastatic cancer may present as endocrine disease, either by release of hormone-like substances or by tumorous destruction of endocrine structures. Metastases of solid tumors to the pituitary gland are often asymptomatic or present with diabetes insipidus. The presentation with a hypofunction of the anterior and posterior lobe of the pituitary gland is a rare event. It is recommended to consider endocrine dysfunction as potential cause of 'malaise' in a cancer patient.
Breast Neoplasms↗
Distribution of Bcl-2 and Bax in embryonic and fetal human skin: antiapoptotic and proapoptotic proteins are differentially expressed in developing skin.
The Bcl-2 protein is involved in the regulation of apoptosis. Bax has an antagonistic effect and enhances cell death. We report that in early gestation, Bcl-2 and Bax colocalize to the epidermal portion of the hair follicle. In the more advanced stages, Bax is located in the compartments where a hair canal is excavated and keratinization and holocrine secretion are initiated, in contrast to Bcl-2, which is expressed in the follicular papilla, preventing apoptosis and underscoring its role as a permanent and stable population of specialized fibroblasts. Scattered dendritic cells located in the basal and immediate suprabasal interfollicular epidermis as well as in the outer root sheath of the developing hair follicle, including the bulge, strongly express Bcl-2 and label for HMB-45, identifying them as melanocytes. The spatial and temporal expression pattern of Bcl-2 and Bax during human hair follicle development underscores their importance for hair biology and most likely is disturbed in the evolution of follicular tumors.
Apoptosis↗
[Juxta-articular fibroid nodules and acrodermatitis chronica atrophicans in late stage Lyme borreliosis].
A 60-years old female patient developed juxta-articular fibroid nodules and erythrocyanotic lesions of acrodermatitis chronica atrophicans after several tick bites. The woman was treated with ceftriaxon (Rocephin) 2 g daily parenterally without adverse reactions.
Acrodermatitis↗
Salvage therapy for relapsed mediastinal B-cell lymphoma with allogeneic HLA-identical related donor bone marrow transplantation, donor lymphocyte infusion and IDEC-C2B8.
Primary B-cell lymphoma of the mediastinum is an aggressive non-Hodgkin's lymphoma with distinct clinicopathologic features. Response rates are between 60-80% following intensive chemotherapy regimens. Poor responders or patients with an early relapse usually do not achieve a prolonged second remission with conventional salvage therapy protocols and therefore qualify for intensive or experimental approaches. Here we describe two patients of same age, gender and stage with primary mediastinal B-cell lymphoma and an early relapse after the first courses of combination chemotherapy and irradiation of the mediastinum. One patient relapsed after a salvage therapy with allogeneic donor-related bone marrow transplantation and donor lymphocyte infusion but responded again with a continuing good partial remission after infusion of the chimeric anti-CD20 antibody IDEC-C2B8. For the other patient an allogeneic bone marrow transplantation was not possible. He finally failed to respond to salvage therapy with IDEC-C2B8 and died of progressive disease. The anti-CD20 antibody IDEC-C2B8 induced a partial remission in a patient with primary mediastinal B-cell lymphoma refractory to other therapeutic approaches, including allogeneic bone marrow transplanatation (alloBMT), donor lymphocyte infusion (DLI) and irradiation. The role of IDEC-C2B8 as a component of salvage regimens appears to be worthy for further evaluation in high-risk patients with primary mediastinal B-cell lymphoma
Adolescent↗
Combined positive/negative purging and transplantation of peripheral blood progenitor cell autografts in breast cancer patients: a pilot study.
This trial studied the feasibility and efficiency of a novel procedure of double purging to eliminate tumor cells from leukapheresis products of stage IV breast cancer patients. After induction and mobilization therapy, 35 leukapheresis products from 16 breast cancer patients were subjected to CD34+ enrichment (i.e., positive selection) with the Isolex 300 device and subsequent immunomagnetic depletion of tumor cells (i.e., negative selection) using a cocktail of three monoclonal antibodies directed against epithelial antigens. Patients with clinical response to induction chemotherapy proceeded to tandem high-dose chemotherapy, which consisted of melphalan (140 mg/m2) followed by retransfusion of the purged graft. After hematologic recovery, patients received ifosfamide 14 g/m2, carboplatin 1.5 g/m2, and etoposide 1.5g/m2 (ICE), again followed by autografting. After positive selection, a median purity of 96.6% CD34+ cells (range 48.4-99.2%) and a recovery of 56.8% (range 25.8-92.6%) were achieved. Subsequent negative purging resulted in a median CD34+ purity of 97.2%. Overall CD34+ recovery after both purging procedures was 51.1% (range 18.5-82.4%). Tumor cells were detectable in 8 of 16 (50%) starting fractions before purging. After both purging cycles, only 1 of 16 autografts remained positive for tumor cells compared to 3 of 16 after CD34+ selection. A calculated purging efficiency of 2 to >4 log was achieved. Engraftment was rapid, reaching > or =500/microL neutrophils on day +10 after melphalan and on day +9 after ICE. A platelet count of > or =20.000/microL was reached on day +12 after melphalan and on day +11 after ICE. Thus, combining positive and negative purging is feasible, further enhances purging efficiency, and does not compromise the quality of the graft, leading to rapid engraftment after high-dose chemotherapy.
Adult↗
Laser-assisted autologous hair transplantation with the Er:YAG laser.
Autologous hair transplantation has become an established therapy for irreversible alopecia. With the advent of CO2 lasers, new procedures have developed. However, CO2 lasers are associated with some disadvantages, and the introduction of the erbium YAG laser has led to further improvements. A case illustration of this technique is given here, and a study of 50 patients has been initiated to further evaluate the potential of this laser.
Alopecia↗
Monitoring of tumor cell purging after highly efficient immunomagnetic selection of CD34 cells from leukapheresis products in breast cancer patients: comparison of immunocytochemical tumor cell staining and reverse transcriptase-polymerase chain reaction.
We studied the efficiency of indirect tumor cell purging via enrichment of CD34+ hematopoietic progenitor cells from leukapheresis products (LP) in breast cancer patients based on immunomagnetic selection of CD34+ cells. Detection of tumor cells was made by immunocytochemical staining. In addition, we evaluated the capacity of cytokeratin 19 (CK19)- and a novel epidermal growth factor receptor (EGF-R)-specific reverse transcriptase-polymerase chain reaction (RT-PCR) for monitoring tumor cell depletion. LP from 13 breast cancer patients were analyzed. Twenty-three CD34 selection procedures were performed. A median of 1.4 x 10(10) total nucleated cells ([TNC] range, 0.88 to 3.5 x 10(10)) with a median CD34 purity of 2.5% (range, 0.4% to 6.3%) were entered into the selection procedure. Immunomagnetic CD34 enrichment resulted in a median purity of 83.3% (range, 45% to 95.4%) and a median recovery of 73.2% (range, 22% to 95%). Retransfusion of CD34-selected cells after high-dose chemotherapy resulted in a rapid and sustained hematologic recovery, reaching an absolute neutrophil count of 500/microL at day +10 and platelet count of 20,000/microL at day +11. Tumor cell depletion was quantified by immunocytochemical detection of CK19-positive cells. By this method, a median tumor cell depletion of 1.9 log (range, 0.7 to > 3 log) could be demonstrated. Immunocytochemical detection of tumor cells was more sensitive than RT-PCR, yielding positive results in 81% of LP (17 to 21) versus 58% positive LP (10 of 17). However, EGF-R-based RT-PCR was much more sensitive than CK19-based RT-PCR (10 of 17 v 1 of 17). Despite highly efficient CD34 selection, tumor cells were still detectable after CD34 enrichment using immunocytochemistry and EGF-R-specific RT-PCR. Thus, this novel EGF-R-specific RT-PCR appears to be of value as an additional method to detect contaminating breast cancer cells within LP.
Adult↗
[Epithelioid cell histiocytoma].
We report on seven examples of this rare, only recently described benign tumor, which presented clinically as solitary elevated nodules on the lower (n = 5) and upper (n = 2) extremity, measuring between 0.6 and 1.1 cm in diameter. Histologically, all tumors were well-defined with a characteristic epidermal collarette. There were abundant (60-80%) epithelioid cells with prominent cytoplasm, a vesicular nucleus and inconspicuous nucleolus, as well as a number of dilated blood vessels. Immunohistologically, tumor cells did not react with monocyte/macrophage antibodies (KP1, MAC387). In addition, there was no evidence of myofibroblastic differentiation (alpha-smooth muscle actin and desmin negative). Thus, while immunohistological markers are helpful to exclude the diagnosis of other tumors, they do not shed light on the differentiation of epithelioid cell histiocytomas. The present cases are identical to those described originally. Recently similar lesions have been described in deeper parts of the corium as well as more cellular forms. Epithelioid cell histiocytoma represents a characteristic, poorly known variant within the spectrum of benign fibrous histiocytomas; it needs to be distinguished clinically and histopathologically especially from Spitz nevus.
Adult↗
[Erythrokeratolysis hiemalis. Erythematosquamous genetic dermatosis with seasonal manifestation].
Erythrokeratolysis hiemalis, keratolytic winter erythema or Oudtshoorn skin has been reported from the South African district of Oudtshoorn as a dominantly inherited dermatosis beginning in early childhood, in some cases with circinar scaling erythemas. Seasonal manifestation in winter-time and a characteristic multi-form histology distinguish this dermatosis from other childhood scaling erythemas. We present clinical, histological and preliminary immunohistological data of a 4-year-old girl with the attributes of erythrokeratolysis hiemalis. No ancestors from the endemic region were traced. The lack of further cases in the family is interpreted as indicative of a spontaneous dominant new mutation.
Child, Preschool↗
[Molecular epidemiology of Neisseria gonorrhoeae: effect of sex and sexual orientation on the distribution of gonococcal types].
Auxotype/serovar (A/S) classification enables precise characterisation of Neisseria gonorrhoeae. In the present study we evaluated whether sex and sexual preference of the patient influence the auxotype/serovar class of the infecting gonococcal strain. In male patients prototrophic/IB-3 was the most frequently isolated A/S class. By contrast, in female patients the A/S class (P)AH(U)/IA-1/2 was significantly (p < 0.005) more frequently isolated than in male patients. Analysis of our data according to sexual preference of the patients showed that in heterosexual patients the two mentioned A/S classes were leading, whereas in homo- and bisexual patients A/S classes prototrophic/IB-2 (p < 0.0001) and Pro/IB-2/16 (p < 0.0001) were isolated significantly more often. Our data are a strong indication that the host environment is also responsible for the selection of N. gonorrhoeae strains with certain typing characteristics.
Adult↗
[Target-like hemosiderotic hemangioma. Further differential diagnosis of Kaposi sarcoma].
Targetoid haemosiderotic haemangioma (THH) can be differentiated from other angiomatous lesions by the characteristic findings on clinical and histological examination. Clinically the solitary lesion is suggestive of a melanocytic or angiomatous origin, surrounded by a haemorrhagic halo in the acute phase. Histological findings vary depending on the duration of the alteration. The pattern has a superficial and a deep dermal component. In the papillary body lesional capillaries are lined by prominent endothelial cells. The surrounding tissue is oedematous and contains masses of erythrocytes or haemosiderin and a lymphocytic infiltrate. Vessels in the deeper dermis have a lymphatic appearance and surround adnexal structures. Further possible similarities with Kaposi sarcoma are dissecting vascular lumina between collagen bundles and spindle cell areas. However, has no atypical cells, eosinophilic globules or apoptotic endothelial cells. Immunohistochemical investigations, which have now revealed BMA 120 for the first time in THH as well as factor VIII-R antigen and Ulex europaeus I lectin, have not so far made any substantial contribution to the differential diagnosis and histogenesis of THH, because markers distinguishing lymphatic from vascular endothelia are still lacking.
Adult↗
Granuloma annulare perforans in herpes zoster scars.
Granuloma annulare perforans limited to a thoracic dermatome that was previously involved by herpes zoster occurred in a 51-year-old woman who also had Lennert's lymphoma. Of the various local granulomatous infiltrates described after herpes zoster, granuloma annulare perforans is unique, although ordinary granuloma annulare has been described in a few patients. A high incidence of specific and nonspecific reaction patterns in herpes zoster scars has been described in patients with malignant lymphoma. In contrast to previous patients, all of whom had chronic lymphatic leukemia, our patient had Lennert's lymphoma.
Back↗
Methylpentylaminopropylidenebisphosphonate (BM 21.0955): a new potent and safe bisphosphonate for the treatment of cancer-associated hypercalcemia.
Bisphosphonates have been shown to be effective in lowering serum calcium levels in patients with cancer-associated hypercalcemia. 1-Hydroxy-3-(methylpentylamino)propylidenebisphosphonate (BM 21.0955) was developed as a third generation bisphosphonate and has been recently proven effective in animals and in patients with Paget's disease or tumor osteolysis. Thirty-six patients with cancer-associated hypercalcemia were treated with increasing doses (0.2-2.0 mg) of BM 21.0955 by single i.v. infusion over 4 h in a phase I trial. Six patients were rejected from analysis due to concomitant treatment with other bisphosphonates or chemotherapy. After rehydration and infusion of BM 21.0955 the mean serum calcium levels fell significantly (P < 0.001), from 3.29 +/- 0.49 mmol/l to 3.04 +/- 0.44 mmol/l until day 2 and normalized on day 6 (2.66 +/- 0.33 mmol/l). Serum calcium was reduced in all patients and normalized in 16. No symptomatic hypocalcemia occurred. Mean serum creatinine decreased significantly (P < 0.01), from 1.25 +/- 0.58 mg/dl (day 0) to 1.05 +/- 0.37 mg/dl (day 6). The mean urinary calcium/creatinine concentration fell significantly (P < 0.001), from 1.90 +/- 1.16 mM/mM (day 0) to 0.37 +/- 0.34 mM/mM/l (day 6). There were no subjective drug-related side effects during or after the infusion. Thirteen patients had elevations of morning body temperature above 38 degrees C. This was due to confirmed infections in five patients and possibly drug- or tumor-related in the other eight. We conclude from these preliminary results that a single infusion of BM 21.0955 is an effective and safe way to treat cancer-associated hypercalcemia.
Aged↗
[Chronic otitis externa from the dermatologic viewpoint].
Chronic external otitis may be divided into several diagnostic categories. Disposition for psoriasis, seborrhoeic and atopic eczema are main endogenous reasons. Exogenous pathogens for external otitis are microbes and allergens. There are numerous interrelations by coincidence of dispositional diseases, e.g. psoriasis and atopic eczema and by combination of exogenous and endogenous pathogens. This holds good for the yeast Pityrosporum ovale vs. orbiculare in seborrhoeic eczema and for the susceptibility to contact (type IV) and respiratory (type I) allergy in atopic individuals as well. Mycotic and bacterial, especially gram negative external otitis are linked to predisposing factors like eczema, long-term microbicidal therapy, hot and humid environment. Contact allergic external otitis may occur during long lasting local therapy with various substances including vehicles, the most common allergen being neomycin. Mucosal allergic reactions (Type I) in the upper respiratory tract may impair ventilation of the Eustachian tube and middle ear and therefore epithelial migration, as a drainage mechanism of the auditory canal. Examination should include functional assessment of the Eustachian tube and middle ear and allergy testing (patch, prick test). Preparations for local therapy should contain a limited number of constituents and avoid common allergens. Surgical procedures to reestablish ventilation of the middle ear are also a therapy for chronic external otitis.
Diagnosis, Differential↗
[Sterile eosinophilic pustulosis (Ofuji)--Mediterranean and endemic case].
Sterile eosinophilic pustulosis (Ofuji's disease) is very rare in Europe compared with Japan. We describe a Turkish and a German case. Clinical and histopathological findings do not allow a clearcut diagnosis. Many differential diagnoses have to be excluded, mainly by histopathological investigations. Careful examination of the heart and other internal organs is also necessary, since Ofuji's disease belongs to the group of hypereosinophilic diseases. Transitions from cutaneous to internal manifestations of hypereosinophilic disease may exist.
Adult↗
[Differential diagnosis of inflammation-induced arterial vascular diseases].
The clarification of non-arteriosclerotic inflammatory vascular diseases is based on angiological, angiographical, immunological and immunohistological methods and parameters. As causes of the arterial occlusive disease of younger patients are taken into consideration the obliterating endangiitis and Takayasu's aortoarteriitis. To the clinical manifestations of the giant cell arteriitis belong the temporal arteriitis and the rheumatic polymyalgia. Hypersensitivity and panangiitides are to be delimited from the group of the pathergic granulomatoses. The secondary Raynaud's syndrome on the basis of a digital arteriitis is of differential-diagnostic and prognostic importance in collagenoses and rheumatoid arthritis.
Arteritis↗
[Lymphogranulomatosis and pregnancy].
A long period of full remission after successfully treated Hodgkin's disease set more and more in our concern problems of pregnancy and parturition in these patients. There are no exact informations about an unfavourable influence of pregnancy on the course of Hodgkin's disease. Although in cases of severe disease the treatment of the mother goes first we will restrain from therapeutical activities in patients with favourable histology and missing B-symptoms. It is reported on 3 cases of Hodgkin's disease with succeeding pregnancy and delivery. The stage IV of Hodgkin's disease in one patient is apparently followed by an uncomplicated course of pregnancy and lack of recurrent disease.
Adult↗