Biomedical subjects
Publications and source records attributed to S Husz.
A 43-year-old woman developed annular and pustular cutaneous lesions preceded by tiny yellow pustules coating the surface of the oral mucosa. The clinical, histological and immunopathological evidence clearly showed that the patient had pyodermatitis-pyostomatitis vegetans. It is suggested that this disease is a distinct entity which should be differentiated from pemphigus vegetans.
Basic food allergens (bread, milk and egg) were investigated in patients with idiopathic chronic urticaria. In 29 of 43 patients, sensitivity could be shown against one or more antigens. The results suggest not only the anaphylactic IgE-mediated reaction in same patients, but also an antibody or cell-mediated mechanisms in the development of the disease. Besides the Prick test, therefore, testing of other circulating antibodies by means of the ELISA technique and the leukocyte migration test is recommended to establish the causative agents in patients with chronic urticaria.
Immunoblotting studies with salt-split human epidermis were performed on sera from 15 patients with pemphigus vulgaris and 20 patients with bullous pemphigoid by using peroxidase-labelled antihuman IgG and IgA. Eleven sera of pemphigus vulgaris antigen. Most of the sera gave additional specific bands at 210 and 80 kD, with lower intensity. The sera of 4 patients, 3 of them were in clinical remission, did not yield specific bands. Seventeen sera of the 20 bullous pemphigoid patients yielded a 220-230 kD protein band against the major bullous pemphigoid antigen and 4 of them gave another specific band at 160-180 kD. Five sera produced multiple bands (220, 130, 100 and 75 kD). IgA antibodies against the major bullous pemphigoid antigen were demonstrated in 2 cases with IgA deposits along their basement membrane, as revealed by direct immunofluorescence. The immunoblot patterns correlated only weakly with the clinical findings in bullous pemphigoid. There was a considerable diversity in both clinical findings and immunoblot patterns.
In an earlier study, the circulating autoantibodies in patients with bullous pemphigoid (BP) were demonstrated in higher frequencies by means of an immunoblot technique then via indirect immunofluorescence. In the present work with the help of Peptide Structure software, two matched antigenic epitopes were chosen and synthesized. The sera of 34 patients with BP were investigated in parallel by an immunoblot technique using a human epidermal extract, and by an ELISA technique with synthetic peptides. The sera of 16 healthy persons and 10 patients with other bullous diseases served as controls. Among the 34 patients with BP, 23 sera proved positive for at least one synthetic peptide. Positive reactions with the major BP antigen (230 kD) were found in 22 patients by immunoblot technique and in 16 patients by the ELISA technique with the synthetic peptide, whereas with the minor BP antigen (180 kD), positive reactions were found in 9 patients by the immunoblot technique and 18 patients by the ELISA technique using the synthetic antigenic epitope of the minor BP antigen. All control sera were negative for both antigens in ELISA investigations. In 3 patients with pemphigus vulgaris, characteristic bands against pemphigus vulgaris antigen were identified by means of the immunoblot technique, but all other cases were negative. It is suggested that the development of this technique may lead to an opportunity for the rapid and simple diagnosis of BP.
Results obtained with the immunoblot technique and indirect immunofluorescence on the specific circulating autoantibodies in 20 patients with bullous pemphigoid and in 15 patients with pemphigus vulgaris were compared. In 17 of the 20 patients with bullous pemphigoid, autoantibodies against the 230 kD major antigen could be demonstrated, and in 9 of these 17 patients more specific autoantibodies against "salt-split" epidermis antigen (220, 180, 130, 100 and 75 kD) were shown. Indirect immunofluorescence were positive only on the sera of 5 of the 20 patients with bullous pemphigoid. The sera of 11 of the 15 patients with pemphigus vulgaris yielded autoantibodies against specific antigen (130 and 85 kD protein). To summarize the results, the immunoblot technique is an excellent method to demonstrate circulating autoantibodies in patients with autoimmune bullous skin diseases and its sensitivity is better than that of the indirect immunofluorescence, procedure. Moreover, it gives a possibility to differentiate among different clinical types.
Specific and sensitive radioimmune methods were used to study the steroid levels and binding capacities of their binding proteins in the serum of 30 women with androgenetic alopecia, in order to establish the proportions of the patients in whom hyperandrogenism or hypercorticism can be detected. It was found that the serum testosterone, dehydroepiandrosterone sulphate and cortisol levels did not differ from those for healthy women except dehydroepiandrosterone which was high. In 5 cases (16.6%), the binding capacity of the "sex hormone-binding globulin" was pathologically low, while in 6 patients (20%) the "free androgen index" was elevated. The binding capacity of the "corticosteroide-binding globulin" was pathologically low in 4 of 21 cases (19%) while the "free cortisol index" was high in 5 of these 21 patients (23.8%). Diane treatment (2 mg cyproterone acetate and 50 micrograms ethinyl-oestradiol)--was administered during 2-5 cycles (8 cases), the pathological dehydroepiandrosterone and dehydroepiandrosterone sulphate levels normalized, the testosterone level decreased to the lower limit of the normal range, the binding capacity of the "sex hormone-binding globulin" increased considerably, and the "free androgen index" fell below the normal range. Diane treatment, an essential improvement was observed in the condition of the patients: the hair became less greasy and its tendency to fall out was likewise moderated.
The functional regeneration of sensory nerves was investigated in 5 patients with skin defects (caused by leg ulcers, a burn or fasciitis necrotisans) after transplantation with a keratinocyte suspension. In this area, first the pain sense and soon after wards the cold and heat sense returned, followed finally by the flare reaction caused by the mustard oil test. No sweat production could be observed during the study, because sweat glands were not found after the keratinocyte transplantation. The reinnervation course is roughly the same for skin defects covered with split skin graft or with a keratinocyte suspension.
Earlier results (the absence or a decreased level of prealbumin [PA] in the serum, a higher proportion of PA-bearing lymphocytes as antigen-binding cells, and the presence of PA in the eluate of lymphocytes in patients with drug allergy) permitted the conclusion that, besides its other relevant functions, PA may also behave as a hapten carrier protein. The lymphocyte transformation test (LTT) involving measurement of 3H-thymidine uptake was therefore carried out with sulphadiminidum (SA) alone, with the PA-SA complex, and with the albumin-SA complex in patients with proven (3 cases) or suspected (63 cases) sensitivity to SA. In all 3 cases with proven drug allergy to SA and in 5 of the 63 suspect cases, the LTT was positive in response to both the drug alone and to the PA-SA complex (The albumin-SA complex gave positivity in only one case). In 5 of the 63 suspect cases, the LTT was positive only in response to the PA-SA complex. It is suggested that the sensitivity of the LTT could be increased if the test could be run with a complex of a protein (hapten carrier?) and a drug.
BACKGROUND: The etiology of cold contact urticaria is unknown and the therapy is therefore usually rather disappointing. METHODS: This study reports therapeutic data on 42 patients with cold urticaria treated with a combination of terbutaline (3 x 5 mg a week, later 3 x 2.5 mg) and aminophylline-containing drugs (3 x 150 mg). RESULTS: Complete remission of the urticarial response was achieved in 37 of the 42 patients. CONCLUSIONS: The therapy was tolerated relatively well and the results are promising.
The detection and typing analysis of human papillomavirus (HPV) were carried out by means of BIOHIT in situ HPV DNA hybridization screening and typing kits in condyloma tissues of patients with genital condyloma acuminatum, in cytological smears of their asymptomatic female consorts, and in female patients with vulval condyloma acuminatum. "Low"-risk HPV 6 and HPV 11 were demonstrated most frequently in the condyloma tissues of the male patients. It is noteworthy that all but one female consorts carried similar HPV type(s) in their cervical smears to those of their sexual partners in condyloma tissues. "Medium" and "high"-risk HPV 18, 31 and 33 types (frequently associated with high-grade dysplastic lesions and carcinomas) were demonstrated more frequently in female condylomas than in male. These three HPV types were identified in both tissues in a female patient with condyloma acuminatum and carcinoma epidermoids cornescens.
The present study demonstrated human papillomavirus (HPV) infection by means of an in situ HPV DNA hybridization screening test (BIOHIT) in 8 male patients with genital condyloma acuminatum, their asymptomatic female consorts and 6 female patients with vulval condyloma acuminatum. The investigations revealed that all but one of the female consorts were infected by HPV but did not show any clinical sign of papillomavirus infection. HPV DNA typing analyses with the most common HPVs present in the genital tract (HPV 6, 11, 16, 18, 31 and 33) revealed the same HPV types in the consorts as found in their partners. (HPV 6 and/or 11 were detected in 4 pairs, HPV 18 and 31 in one pair each, and HPV 18/31 and 16/31 double infections in one pair each.) All cytological specimens of female patients with condyloma acuminatum were HPV-infected, the most frequent type being HPV 31. In the one patient with vulval condyloma acuminatum and carcinoma epidermoides cornescens, the "high-risk" HPV 18 was identified in both condyloma and carcinoma tissues.
The authors present the case of a thirty-six-year-old woman with systemic lupus erythematosus with specific vesiculobullous symptoms. Degos dermal infarcts and Schönlein-Henoch-type purpura was observed in the course of her illness. Attention is drawn to the rarity of this symptom group, which has not been documented in previous publications. Degos lesions accompanying the systemic lupus erythematosus were benign. The effectiveness of sulfone in the treatment of vesiculobullous symptoms in this case is noted.
Antibodies against ENA (Extractable Nuclear Antigens), SSA/Ro and SSB/La were investigated in parallel in the serum and the immune complex precipitates of 41 patients with autoimmune disease (10 systemic lupus erythematosus, 23 discoid lupus erythematosus, 3 subacute cutaneous lupus erythematosus, and 5 progressive systemic sclerosis). It was demonstrated that in some cases the autoantibody spectrum of the serum did not coincide with that of the immune complex precipitate. In the majority of patients the protein content of isolated immune complexes was increased and the increase was attributed to IgG solely. In some patients antibodies appeared not only in the serum but also in immune complex, even in 4 patients (2 systemic lupus erythematosus, 1 subacute cutaneous lupus erythematosus, and 1 progressive systemic sclerosis) antibodies were detected only in the immune complex precipitate.
The case of a 36-year-old woman with typically fixed drug eruption is reported. A detailed case history and the diary of the patient helped to reveal the drug (Novorin nose drops) which caused the disease. It was proved by the lymphocyte transformation test.
A case of subcorneal pustular dermatosis associated with IgA multiple myeloma is described. The significance of the combination of the two diseases is not yet known, but the association is certainly more than coincidence.
The characteristics of primary Sjögren's syndrome are described on the basis of the follow-up of 65 patients with extraglandular symptoms at the onset and during the disease. The mean age of the patients at onset was 41.8 years and at the time of definite diagnosis was 45.8 years. Articular (32 cases), lacrimal (30 cases) and salivary (30 cases) manifestations were the most frequent initial symptoms. In only 22 of the 65 patients could Sjögren's syndrome be diagnosed at the onset. In most cases, the articular symptoms observed observed in 56 patients during the course corresponded to true polyarthritis, as verified by joint scintigraphy. Most frequently the wrists and ankles were affected. Chronic atrophic gastritis was found in 35 patients. In the young patients (13 cases), both the antrum and the corpus were affected more frequently than in the controls. In middle-aged patients (21 cases), atrophy of the antrum, and in the elderly (10 cases) atrophy of the corpus was more frequent than in the controls. All three types of chronic atrophic gastritis occurred in the disease. The decreased gastric acid secretion was characteristic of types A and AB gastritis, but the hypergastrinaemia only of type A. It was verified that chronic duodenitis and jejunitis occur in the disease. The pancreatic lesions were mild. Renal involvement was detected in 15 patients, vascular symptoms in 22 and lower-airway changes in 21. The variety of the different symptoms proved that primary Sjögren's syndrome can involve many organs.
Serological features were investigated in 22 patients with polymorphous light eruption. The diagnosis was made from the history and clinical patterns and confirmed by phototesting and histological examinations. In 4 patients with polymorphous light eruption, anti-RNP antibodies were detected in the serum despite the fact that the antinuclear antibody tests were negative in all cases. The serum levels of anti-SSA/Ro antibodies in the patients were mildly but significantly elevated (p less than 0.001) as compared with healthy controls. No difference was found between the patients and controls regarding the serum concentrations of anti-SSB/La antibodies. The conclusion is drawn that it is necessary to examine patients with polymorphous light eruption with regard to a 'late autoimmune course' and it is worthwhile to study the relationship between the photosensitivity and the occurrence of anti-SSA/Ro antibodies.
Urtica is characterized by an erythematous wheal surrounded by a flare and is frequently caused by physical agents (e.g. cold). The exact mechanism and mediators involved in the mechanism of physical urticaria are not known. This study of the role of the neurogenic factors in cold urticaria showed, that local capsaicin treatment (desensitization) of the skin in patients with cold urticaria resulted in the abolition of whealing in response to cold. This result suggests that C-fibers might play an important role in the pathomechanism of idiopathic contact cold urticaria.