Itraconazole and cyclosporin nephrotoxicity.
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Biomedical subjects
Publications and source records attributed to G Veltman.
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298 patients suffering from eczema were tested for alkali-resistance by means of the method according to Burckhardt-Locher (ARBL) as well as patch-testing. If ARBL revealed decreased alkali-resistance, there was a high correlation with the outcome of the patch-test of alkalis. If ARBL showed normal values, however, additional patch-testing detected reduced alkali-resistance in 42.9% of the cases. In order to make a well-founded diagnosis of alkali-resistance, we suggest to combine both methods and/or to include a control of ARBL after 24 hours as proposed by Burckhardt.
A chronic hepatic disorder of porphyrin metabolism was found in 36 workers with vinyl chloride (VC)-induced hepatic injury following long-time industrial exposure. Pathologic porphyrinuria, especially secondary coproporphyrinuria with transition to subclinical chronic hepatic porphyria, is a consistent pathobiochemical parameter for the recognition of VC hepatic lesions. The porphyrinuria is of diagnostic value for the incipient toxic phase. Erythrocyte uroporphyrinogen decarboxylase activity studied in six cases with initial chronic hepatic porphyria was normal, suggesting that VC affects only this enzyme in the liver.
Benign symmetric lipomatosis or Launois-Bensaude syndrome is a condition characterized by diffuse, unencapsulated, painless growth of lipomatous tissue with a peculiar symmetric topology occurring predominantly in middle-aged men. In the present study a short survey of the clinical manifestations, differential diagnosis, current pathophysiologic theories, and therapy of this disease is given. From the literature published since 1950 112 observations are reviewed with respect to alcohol abuse in the premorbid period and other coexisting illnesses. Of the patients 70% were heavy drinkers and in over 45% significant liver damage was present. In addition, two rare cases of benign symmetric lipomatosis in women, aged 42 and 49 years, respectively, are presented. Both were alcoholics with hepatic sequelae. The possible existence of a female morphological subtype of benign symmetric lipomatosis is ventilated and its identity with Touraine-Renault's segmental lipomatosis of the trunk suspected.
After critical evaluation of literature as well as the results obtained in this department up to now concerning skin tests and therapy with whole body extracts, we changed our mode of treatment of sting allergy to desensitization with pure insect venom. Clinical observations concerning the course of the rapid desensitization led to an accentuation of the local reaction as an important sign of the compatibility of the therapy. On account of local reaction patterns concerning the dosage of the venom, a significant reduction of the rate of side effects could be achieved in this high risk therapy.
109 provocations with rhinomanogram were performed, 107 of them showed the following results: When there was a skin reaction of 2/5 according to Hansen, provocation and strength of intracutaneous test revealed a significant correlation. The most eminent win of information was achieved in 61% by challenge with housedust, whereas it was about 30% by challenge with mite or pollen. The most important indication for nasal challenge is the control of the clinical relevance of an allergen in view of a planned hyposensitization therapy. In particular, a nasal challenge should be performed prior to a hyposensitization with housedust and when the history of the patient and the results of intracutaneous tests are contradictory.
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Workers engaged in the PVC-production, who were long-term exposed to the gaseous base vinyl chloride exhibit a complex pattern of damages. Changes of the skin, vascular and bone system, as well as thrombocytopenia, liver fibrosis with portal hypertension, disturbances of the porphyrin metabolism and alterations of the central nervous system were observed. Moreover vinyl chloride is oncogenic and may cause angiosarcoma of the liver. By directed occupational medicine supervision, improvement of the production conditions and introduction of new processing techniques health risks at the workplace could be eliminated to a far extend.
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The VC-disease is another example of the constant threat working people are exposed to. A resonable collaboation of all competent bodies will allow to minimize the hazards or to remove them, and thus to "humanize" the working conditions. The VC-disease should be recognized as an occupational disease, the maximal concentration of VC at the working place should be standardized. New chemical products of considerable economic importance such as VC should be examined carefully before being commercialized.
Occurence of severe liver damage including angiosarcoma in polyvinyl chloride production workers necessitates regular control investigations of liver and spleen. Radioisotope techniques with small irradiation doses which give valid results should be used. Investigations of 15 patients with PVC-induced liver disease showed that hepatic perfusion as demonstrated by 99mTc pertechnate does not correlate with the uptake of sulphide colloid in the hepatic reticuloendothelial system. This provides evidence that in VC disease specific damage of the reticuloendothelial system of the liver occurs. Sequential scintigraphy also proved that the liver perfusion quotient can be considered as a measure of portal pressure. In practice this may be used for follow-up controls. Vascularized tumours described in VC disease can also be demonstrated by scintigraphy.
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An occupational sensitization of the respiratory tract caused by hair and dust of laboratory animals (Mastomys natalensis) was reported in 3 persons. Intracutaneous tests confirmed the relationship between the professional activity and the clinical symptoms of an inhalation allergy. The very pronounced reaction to different dust extracts and the special conditions of exposure suggest an occupational sensitization to the dust of laboratory animals.
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