Biomedical subjects
Publications and source records attributed to H H Wolff.
Lichenoid keratosis is a usually solitary skin lesion occurring in sun-exposed areas. It is macroscopically uncharacteristic, resembles actinic keratosis, basal cell epithelioma, Bowen's disease, or flat seborrheic keratosis, but shows histologically the typical pattern of lichen planus. Lichenoid keratosis should be differentiated from the lichenoid variant of actinic keratosis.
Two patients with disseminated glomus tumors (glomangiomas) are reported. Histologically, the angiomatous from typical of multiple glomus tumors was found. Th glomus tumors are related to the arterio-venous anastomoses (organ of Hoyer-Grosser). The most important histological variants are the epithelioid and the angiomatous type. Possibly, the former is related to the arterial segment, the latter to the venous segment of the normal arterio-venous anastomoses. The histological identification of glomus cells is diagnostic. The nature of these cells has been under discussion since Masson's time. Ultrastructurally, they have been clearly identified as modified smooth muscles cells. Electron-microscopy can be helpful in the differentiation of glomus tumors from hemangiopericytomas which may sometimes be difficult histologically.
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1. A case of the very rare "disseminated cicatricial pemphigoid" is presented in a 68-year-old man. Clinically, prurigo-like nodules and keloidiform plaques, tense blisters and tight atrophic scars were disseminated in the occipital region, on the trunk and on the extremities. The mucous membranes were never affected. 2. Histologically, subepidermal blisters were found. The blister roof contained the complete, intact epidermis; in the floor of the blisters, fibroplasia, angioplasia, and a scarce inflammatory infiltrate containing some eosinophils were present. 3. Direct immunofluorescence revealed linear precipitates of IgM and C3 in the basement membrane. Circulating antibodies have not been found. 4. Semithin sections and electron microscopy showed subepidermal microvesicles and fibrin deposits in initial lesion, followed by edema and blister formation within and below the fibrin deposits. 5. Among several trials of treatment, only azathioprine (Imurek) seemed effective.
The present study was done to elucidate the pathogenesis of aphthae in recurrent oral ulcers and Behcet's disease. Histologically, early stages of aphthae showed a predominantly neutrophil infiltrate and leukocytoclasia in the vessel walls, as well as extravasates of erythrocytes. In later stages, also histiocytes and lymphocytes appeared. By direct immunofluorescence technique, 30 of 34 patients showed perivascular precipitates of C3 and Clq, eight patients in addition, IgM and IgG. Remarkably, band-like fine granular precipitates of C3 were present in the basement membrane zone. By immunoelectronmicroscopy, C3 was demonstrated in fine subendothelial granules of the vessel walls and of the epithelial basement membrane below the lamina densa. There were no fundamental differences between the aphthae of recurrent oral ulcers and Behcet's disease. Our findings indicate, that an immunecomplex vasculitis is involved in the pathogenesis of aphthosis.
The tick Ixodes ricinus was examined with a scanning electron microscope. The morphology of the mouth parts explains the well known tight attachment of the head of the tick in the skin. Diseases following tick bites and the possibilities of removing the ticks are discussed.
According to reports in the literature and the results of our own double-blind trial benzoyl peroxide at a 20% concentration in an oil-in-water emulsion (Benoxyl 20) is a very effective medication especially in problem ulcers. The benefit probably outweighs the considerable dangers of application in the indication mentioned which may consist of a selection of certain gram-negative organisms and an epicutaneous sensitization.
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Fabry's disease is an inborn error of sphingolipid metabolism. The lysosomal hydrolase, alpha-galactosidase, is deficient. The full spectrum of symptoms (diffuse angiokeratoma, alpha-galactosidase deficiency) is only seen in males, who are always hemizygous. The heterozygous females may be asymptomatic and the enzyme activity can be normal. Such a case is reported. The diagnosis of this case was made by electron microscopic findings of the characteristic cellular lipid-inclusions within endothelial, perithelial, smooth muscle, and nerve sheath cells. The electron microscopic findings are a valuable clue to the diagnosis in these problem cases. The early diagnosis of female conductors is important for genetic counseling.
Report of a patient with multiple myeloma and cryoglobulinemia, typical skin lesions and unusual neurologic symptoms.
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The therapeutic effect of levamisole was tested in a double blind and open clinical study in 30 patients with recurrent labial and genital herpes simplex. The frequency, the duration and the painfulness of the herpes eruptions were improved significantly under levamisole treatment. Agranulocytosis is an important adverse reaction which restricts the practical use of the substance. The increase of phagocytosis of granulocytes and macrophages and the normalization of defective cell mediated immune reactions are the supposed mechanisms of levamisole action.
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1. A typical case of Erythema elevatum diutinum (E.e.d.) with extracellular cholesterosis is described clinically and histologically in a 48-year-old woman. The disease had a course of 15 years. 2. Electron microscopy confirmed the histological and immunfluorescent findings of leucocytoclastic vasculitis. In older lesions, histiocytes/macrophages predominate. Intra- and extracellular lipid depositions showed a variety of ultrastructural characteristics which differed from electron microscopical findings described in other disorders associated with lipid deposition. 3. The findings are in accordance with the hypothesis that the primary event in E.e.d. is a special type of chronic leukocytoclastic vasculitis. Subsequently, the damage of the vessel walls and focal necrosis may lead to secondary lipid deposition.
A leukocytoclastic vasculitis was induced by intracutaneous injection of streptococcal antigen in a patient with erythema elevatum diutinum (E.e.d.). The immunoelectronmicroscopical demonstration of C3 was performed by use of the peroxidase-antiperoxidase multistep technique 24 h after the injection of the antigen. Deposits of C3 were found between endothelial cells, on the outer surface of endothelial cells, pericytes, and smooth muscle cells, as well as within the multilayered basal lamina of small vessels. Intact and disintegrating neutrophils accumulate within the vessel walls and in their surroundings. Necrosis and fibrin deposition are present in advanced stages. The findings demonstrate the sequence of events in leukocytoclastic vasculitis at the ultrastructural level. They also support the hypothesis that in E.e.d. an Arthus type reaction induced by bacterial antigens may be of pathogenetic significance.
Enzyme cytochemical (hydrolytic enzymes for cell differentiation), immunocytologic (B and T lymphocyte differentiation), and electron microscopic studies of skin infiltrates facilitate the proper diagnosis of myelomonocytic and lymphoreticular proliferations. With use of these methods, the original clinical diagnosis of malignant reticulosis of the skin was corrected to monocytic leukemia in a 65-year-old woman. Because primary involvement of the skin preceded monocytosis of the blood, it was concluded that the cutaneous infiltrates in our patient resulted from proliferation of tumor cells in the skin rather than from homing of the cells to, or settling of the cells in, the skin.
In 4 cases of allergic vasculitis circulating immune complexes (IC) were demonstrated. Spontaneous and histamine induced vascular changes were studied by immunofluorescence microscopy. The early events in IC vasculitis were investigated at the ultrastructural level by immunoelectronmicroscopy using the peroxidase-antiperoxidase multistep technique. Our findings support the concept that human IC vasculitis is triggered by the deposition of circulating IC in the walls of postcapillary venules between endothelial cells, pericytes and the layers of the basal lamina. Tissue destruction is only secondary due to local complement activation and the release of lysosomal enzymes from chemotactically attracted leukocytes.