Biomedical subjects
Publications and source records attributed to F M Köhn.
Acquired disorders of hair growth in women may present clinically either as effluvium or alopecia. The relevant pathologies include androgenetic alopecia, postpartum effluvium, tinea capitis, trichotillomania and alopecia areata.
Diabetes mellitus may be associated with dermatological lesions affecting the skin and mucous membranes. In some cases they may even provide the physician with a first indication that the patient may be suffering from diabetes. Typical examples include necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and vitiligo.
Crohn's disease or ulcerative colitis may be preceded, followed or accompanied by a variety of extra-intestinal diseases affecting the skin and mucous membranes. Amongthe most important of these associated lesions are, for example, erythema nodosum and pyoderma gangrenosum.
Fibroblast proliferation is a key process in tissue remodeling and mast cells (MCs) are thought to play a crucial role. Having established that the three major MC products, tryptase, histamine and TNF-alpha (TNF) are normally present in human skin MCs, which are in close proximity to dermal fibroblasts, we studied their individual effects on cell cycle-controlled human dermal fibroblasts (HFFF2). These cells express receptors (H1, PAR2, TNFR1/2) for the major MC mediators, but only tryptase or a PAR2 agonist peptide stimulated proliferation and gene expression. TNF was antimitotic, and histamine, while elevating intracellular Ca2+ levels at high concentrations, did not affect proliferation. We conclude that MC products but also composition and numbers of respective receptors on fibroblasts are crucially responsible for fibroproliferative events.
Human seminal plasma hypersensitivity has to be differentiated from allergic reactions to latex, spermicidal agents, local anesthetics or components of lubricants. The present review article discusses IgE-mediated allergic reactions (type I) to specific components of the seminal plasma. Such incidents are rare, even though there seems to be a considerable number of unreported cases. Since the first publication in 1958, human seminal plasma allergy has been increasingly recognized, and approximately 80 cases have been described. Most affected women are younger than 40 years, presenting with an atopic family history. Anaphylaxis to components of the seminal plasma is not always associated with infertility. Complaints occur immediately or within 1 h after contact with seminal plasma. Local reactions include itching, burning, erythema and edema in the vulvar region or other sperm contact sites. Systemic reactions are experienced as dyspnea, dysphagia, rhinoconjunctival complaints, generalized urticaria, angioedema, gastrointestinal symptoms, exacerbation of existing atopic eczema or anaphylactic shock. Recently, it has been reported that human seminal plasma anaphylaxis may also present as 'vulvar vestibulitis syndrome' or 'burning semen syndrome'. These symptoms may occur during the first sexual intercourse. Some results are indicative of allergens originating from the prostate, prostate-specific antigen being clinically relevant. The diagnosis of human seminal plasma allergy is based on history, demonstration of specific IgE antibodies in the serum and skin tests. Therapeutic options include allergen avoidance by use of condoms and attempts at desensitization.
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Sexually transmitted infections caused by viruses include infections by the Herpes simplex virus (HSV), the human papillomavirus (HPV), and the human immunodeficiency virus (HIV). The diagnosis is established on the basis of clinical presentation and the direct demonstration of the antigen or antibodies.
Bacterial infections that can be transmitted by sexual contact are usually caused by the following organisms: Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum and Klebsiella granulomatis. These pathogens can be detected with the aid of specific nutrient media, stained microscopic sections and serological and molecular biological methods.
Ectoparasites, such as lice and itch mites (scabies) as well as yeasts, may be transmitted not only by sexual contact, but also by less intimate skin contact. The nits of the louse are visible to the naked eye, while Candida albicans is detected under the microscope or by culture.
10-20% of the men who seek the help of an andrologist present with azoospermia. Possible causes are of genetic origin or are acquired disorders of production and transport. On the basis of a comprehensive andrological work-up this disturbances can be identified. In this connection important parameters for the clarification of azoospermia include patient history, endocrinal laboratory examinations, analysis of the ejaculate and genetic investigations. In addition to medication, microsurgical interventions may be useful. For assisted reproduction, sperm is harvested operatively from the testes or microsurgically from the epididymis.
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Allergy is a very uncommon cause of diarrhoea. Other mechanisms, medical diseases and infections, psychological and pseudoallergic reactions, intolerance reactions, and enzyme defects/deficiency, and many other conditions are much more common. If food allergy is strongly suspected diagnosis may be difficult, even for allergologists, as it requires a mosaic of history, skin and in vitro tests, diagnostic diet, and even provocation tests. It is important to recognise diarrhoea "accompanying" allergic urticaria and anaphylactic reactions as part of the symptomatology of the primary dermatological or allergic disease and to refer the patient to the appropriate specialist.
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To date, we have no uniform definition of ejaculatio praecox. In a qualitative approach, premature ejaculation is ascribed to a failure to control excitement. As causes, organic disorders and erectile dysfunction must be excluded. The majority of cases, however, are due to psychological or partnership problems. The history-taking should aim, in particular, to uncover possible anxiety in conjunction with premature orgasm, and also to establish the reactions of the partner. As therapy, medication (local anesthetics, antidepressive agents, PDE-5 inhibitors) and sexual-therapeutic measures are available. Since few sufferers take the initiative in seeking treatment, particular importance attaches to providing the public with information about the therapeutic options for treating this common disorder.
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Numerous skin diseases, for example psoriasis, eczema, lichen planus, Reiter's syndrome or alopecia areata, may also involve parts of the nail. Depending on the structure involved and the nature and duration of the lesion, a certain disturbance pattern presents. Matrix disorders, which are often observed, may manifest as such characteristic lesions as spots, tracheonychia or Beau's lines. Treatment is determined by the respective underlying disease.