[Use of the TDF factor in soft roentgen radiotherapy]

In a prospective randomized study 164 patients with altogether 142 basal cell carcinomas and 24 squamous cell carcinomas were each irradiated with a single dose of 3 Gy daily on 20 consecutive days, giving a total dose of 60 Gy (TDF factor 123). In another group of 155 patients, with altogether 148 basal cell carcinomas and 20 squamous cell carcinomas, each patient received 4 Gy 3 times per week until 12 irradiations had been administered, giving a total dose of 48 Gy (TDF factor 103). The cure rates in patients with basal cell carcinomas did not differ between the two groups: 90% were cured by the higher total dose and 92%, by the lower dose. The high dose regimen brought about a cure in 96% of squamous cell carcinomas, in contrast to only 85% with the low dose regimen. Owing to the small number of patients the difference was not statistically significant. These data demonstrate that basal cell carcinomas can be controlled by low-dose irradiation regimens. Squamous cell carcinomas may have a lower radiosensitivity than basal cell carcinomas and may require higher doses.

[Androgenetic alopecia in the male. Recent developments]

In this review male-pattern baldness [androgenetic alopoecia (AA)] is discussed. AA is characterized as a physiological process. Some of the reactions that take place in its pathogenesis and many of the substrates involved in androgen metabolism are now known, but the question as to the androgen stimulus leads to retrograde transformation of the hair follicles only in skin of the parieto-occipital scalp can still not be answered. Specific antiandrogens for the treatment of AA are not available for either topical application or systemic administration. Minoxidil seems to have a positive effect in the treatment of AA but in most cases the cosmetic result is not satisfactory.

Excisional biopsy as the first therapeutic procedure versus primary wide excision of malignant melanoma

The five-year disease-free rate (5-y-DFR) and five-year survival rate (5-y-SR) of 319 melanoma patients with a narrow excisional biopsy in local anesthesia as the first procedure followed by delayed wide excision, were compared with 5-y-DFR and 5-y-SR of 635 primary radically treated patients. Five-y-DFR and 5-y-SR did not differ in either group of patients. Furthermore, the time interval (less than or equal to 21 days versus greater than 21 days) between excisional biopsy and delayed wide excision had no influence on the outcome of the patients. Based on the results of the study and the literature, excisional biopsy of malignant melanoma followed by delayed wide excision is a safe procedure.

[Chronic lichenoid keratosis: disease variant or disease entity?]

The presentation of a new case of keratosis lichenoides chronica (KLC) in a 61-year-old woman lead us to this comprehensive study of the cases already published in the literature. The clinical and histological substrate of KLC and its differential diagnosis and treatment are discussed in detail. The clinical appearance is mainly characterized by an eruption of (1) lichenoid, keratotic papules, (2) linear or plaque-like keratosis, and (3) psoriasis-like scaling lesions on the trunk and extremities. The course of the disease is chronic and progressive. Histopathological study shows variable features, which are similar to those of lichen planus only on rare occasions. This dermatosis does not show any pathological relationship with other dermatological conditions; we therefore suggest that KLC is a distinct entity.

[The number and distribution of nevus cell nevi in patients with malignant melanoma]

Total-body cutaneous examination of 211 patients with malignant melanoma (MM) and 157 controls showed that patients with MM had significantly more nevi. Among MM patients, men had more nevi on the trunk than women, and women had more nevi on the lower extremities than men. Men had an MM distribution that was similar to their nevus distribution. Women, however, had proportionately more MM on the legs and fewer MM on the neck. The "nevus density," defined as the number of nevi per unit surface area of skin, was higher in male MM patients. The nevus density was highest on the head and neck, and lower on the lower extremities and anterior trunk. Patients with nodular melanoma had more nevi than those with superficial spreading melanoma. MM patients with a family history of many nevi had more nevi than those without such a history. Patients with a family history of MM did not show an increased number of nevi, but they had larger numbers of suggestive nevi removed than those without a family history of MM. We believe that many of these observations are consistent with the view that MM is caused by a genetic predisposition to an overactive melanocytic system in combination with an external stimulant, such as UV radiation.

[Spectrum of antinuclear and anti-cytoplasmic antibodies in dermatomyositis and polymyositis overlap syndromes]

Antinuclear antibodies (ANA) of the IgG class were detected in 60% of patients with dermatomyositis. Only in 16% could we demonstrate precipitating antibodies against the nuclear Mi-2 antigen. These antibodies are considered to be serological markers of dermatomyositis. The ANA spectrum in polymyositis-overlap syndrome was considerably more heterogeneous: patients with polymyositis/progressive systemic scleroderma overlap had antibodies against the nucleolar PM-Scl antigen or the nuclear Ku antigen. Cytoplasmic antibodies to Jo-1 were present in polymyositis associated with Sjögren's syndrome and pulmonary fibrosis. Antibodies against ribosomal ribonucleoprotein were found in polymyositis with systemic lupus erythematosus and antibodies to nuclear ribonucleoprotein in polymyositis associated with mixed connective tissue disease. The investigation demonstrates that the characterization of ANA specificities helps to differentiate between dermatomyositis and distinct forms of polymyositis-overlap syndrome.

[Fibrocytes and fibroblasts. Definition and significance in wound healing and fibrotic diseases of the skin]

Fibroblasts are not only responsible for connective tissue synthesis in the dermis, but in addition have to fulfill several functions including chemotaxis, attachment and proliferation as well as tissue remodelling. They interact with various molecules of the extracellular matrix which to a certain extent can regulate some of these cellular functions. Furthermore fibroblast metabolism is influenced by cytokines released by other cells. Some of these factors e.g. TNF, TGF-beta or interferon-y have been shown to regulate specifically some functions whereas others can modulate the cellular differentiation. An exact knowledge of the interaction with the extracellular matrix and the response to various cytokines released during pathological conditions is required for the understanding of altered fibroblast metabolism leading to wound healing defects or fibrosis.

[The history of dermatology and venereology at the General Hospital on the banks of the Isar in Munich (1813-1929)]

Between 1831 and 1929, the department of dermatology and venereology in Munich achieved an outstanding reputation for excellence, which was recognized both in Germany and elsewhere. Such eminent personalities as Joseph von Lindwurm and Leo Ritter von Zumbusch were especially influential in this development.

Pseudo-Kaposi's sarcoma occurring after placement of arteriovenous shunt. A case report with DNA content analysis

Pseudo-Kaposi's sarcoma developed in a 51-year-old man 2 years after placement of an arteriovenous shunt for hemodialysis. Data from histopathologic, immunohistologic, and histochemical studies, electron microscopy, and DNA-cytometric analysis are presented.

Follicular lymphoid hyperplasia of the skin with high content of Ki-1 positive lymphocytes

We report the case of a spontaneously regressing lymphocytic lesion on the neck of a 76-year-old man. Routine histopathological examination revealed a heterogeneous infiltrate composed of both lymphoid follicles and preferentially perifollicular and interfollicular sheets of large atypical cells. Immunohistologically, large atypical cells were positive for Ki-1/Ber-H2 (CD30), anti-Il-2 (CD25), Ber T9, anti-HLA-DR, Leu-5b (CD2), T3 (CD3), Leu-3 (CD4), Leu-1 (CD5) and, occasionally, Leu-M1 (CD15); that is, they showed an arrangement and immunophenotype similar to those of perifollicular Ki-1 positive cells in reactive lymphoid tissue. In contrast, antibodies To15 (CD22), anti-immunoglobulins, and anti-CALLA (CD10) stained polyclonal B-cells restricted to lymphoid follicles and small clusters representing remnants of follicles. We suggest that this lesion be termed "follicular lymphoid hyperplasia of the skin with high content of activated T-helper cells."

Primary and secondary cutaneous Ki-1+ (CD30+) anaplastic large cell lymphomas. Morphologic, immunohistologic, and clinical-characteristics

Skin biopsies were collected from 15 patients with cutaneous tumors morphologically similar to Ki-1+ anaplastic large cell (ALC) lymphoma of the lymph nodes, including Ki-1+ ALC lymphoma of childhood. The histology and immunophenotype of these cutaneous tumors are reported and follow-up data on the patients are given. The tumorous infiltrates were composed of large, sometimes very bizarre cells with one nucleolus or multiple nucleoli. All tumor cells expressed the lymphoid cell activation antigen Ki-1 (CD30) in conjunction with CD25 and the beta-chain of the T cell receptor. In 11 patients, Ki-1+ cutaneous tumors developed primarily in the skin. In nine patients, these were restricted to the skin in follow-up periods ranging from 3 months to 6 years. Two patients developed lymph node involvement after 2 months and 2 years, indicating the spreading potential of these cutaneous tumors. Morphologic and immunophenotypical identity of the atypical cells found in primary cutaneous ALC lymphoma, in regressing atypical histiocytosis (RAH), and in lymphomatoid papulosis (LyP) of type A, together with the protracted clinical course in all three conditions, suggests that primary cutaneous ALC lymphoma, RAH, and LyP of type A represent clinical variants of the same lymphoma entity. Secondary development of Ki-1+ ALC skin tumors was observed in two patients with cutaneous T cell lymphomas of mycosis fungoides type. These secondary Ki-1+ ALC lymphomas of the skin showed rapid systemic progression similar to the primary lymphonodal Ki-1+ ALC lymphomas. Concomitant or subsequent occurrence of Ki-1+ ALC tumors in cutaneous T cell lymphomas thus may be a bad prognostic sign.

Occurrence of IgE-bearing epidermal Langerhans cells in atopic eczema: a study of the time course of the lesions and with regard to the IgE serum level

Uninvolved and lesional skin of untreated and treated patients with atopic eczema has been investigated immunohistochemically to determine the conditions in which IgE-bearing CD1a+ Langerhans cells/indeterminate cells (LC/IC) occur in this disease. IgE-bearing epidermal dendritic cells were present in patients with elevated IgE serum level (greater than 300 UI/ml) and the staining pattern was stronger in lesional skin. On double immunostaining, a subpopulation of CD1a+ LC/IC was found not to bear IgE molecules as determined by the ratio IgE+/CD1a+ cells on serial sections as well. The ratio IgE+/CD1a+ cells decreased in patients who underwent a local therapy with glucocorticosteroids. These results suggest that the expression of IgE receptors and/or binding of IgE molecules on epidermal LC/IC in atopic eczema may be controlled by a complex network of mediators from the epidermis or the inflammatory infiltrate, or both, and that this phenomenon could be down regulated by glucocorticosteroids.

[Malignant atrophic papulosis (Köhlmeier-Degos disease)]

On the basis of 106 patients with malignant atrophic papulosis in the literature, including one case of our own, the clinical, histopathological and nosological features of this disease are reviewed. Histopathologically, the typical papules with central porcelain-white atrophy show broad wedge-shaped necrosis of the connective tissue due to thrombotic occlusions of small vessels in the corium. The disease leads to death in 50% of these cases, mostly due to involvement of the gut and the central nervous system. Malignant atrophic papulosis is the prototype of a disease, in which skin lesions are the primary sign of a systemic disorder demanding the interdisciplinary cooperation of various specialists.

[Late metastasis in malignant melanoma of the skin]

Among a total of 680 patients with advanced malignant melanoma, the interval between removal of the primary tumour and first manifestation of tumour progression was more than five years in 47 (6.9%: 28 women and 19 men, mean age 45 [range 27-70] years), more than 10 years in ten of them. In only eight was the thickness of the primary tumour more than 3 mm. A total of 29 patients died after the tumour progression. Survival time ranged from 1 to 120 months, mean 18 +/- 23 months. There was no correlation between manifestation-free interval and survival time after the first progression had occurred. It is concluded from these findings that patients with malignant melanoma should be followed up for at least ten years.

[Diagnosis and therapy of ulcus molle today. Case report and review of the literature]

Chancroid, an ulcerous disease of the genitalia caused by Haemophilus ducreyi, occurs rarely but regularly in Germany. Exact diagnosis is based on the clinical features and a direct smear, and in particular on cultivation of the organism, showing its unique macromorphological characteristics. The sensitivity of cultivation has increased due to the development of selective media for primary isolation. Resistance problems during the last decade meant that a change to new therapeutic strategies was unavoidable. The work presented here includes a case report and a review of the recent literature, it illustrates modern methods of diagnosis and treatment of Haemophilus ducreyi infections 100 years after the first description of the organism.

[The etiopathogenesis of ulcus molle: current status of knowledge--approaches to future research]

Chancroid is a sexually transmitted disease characterized by genital ulceration. Although the pathology of chancroid lesions has been well described, we still know relatively little about the mechanism by which the causative agent, the bacterium Haemophilus ducreyi, produces disease. It is hoped that a better understanding of both the pathogenicity of H. ducreyi and the pathogenesis of chancroid will provide a rational basis for the development of improved strategies for the control of this disease.

[Morphologic variants of genital ulcer caused by Haemophilus ducreyi]

The typical clinical picture, common variants and frequent complications of chancroid are presented in cases proven by culture. In general, the conventional view of the clinical spectrum of chancroid is substantiated. Certain types such as "chancre mou volant," however, could not be found in the present material. Their existence or association with Haemophilus ducreyi remains speculative.

Semiquantitative analysis of histologic criteria in thin malignant melanomas

To evaluate the sensitivity of histologic criteria 396 hematoxylin-eosin-stained step sections of 150 randomly sampled thin malignant melanomas (tumor thickness, less than or equal to 1.5 mm; level of invasion, I-III) were analyzed. The highest sensitivity was determined for nuclear atypia (84%), followed by the asymmetry of the lesion (81.3%) and the presence of single cells in the upper layers of the epidermis (80.3%). The sensitivity was limited for the inflammatory reaction of the dermis (56%), poor demarcation of the lesion (49.3%), and infiltration of the adnexa (47.7%). For the mitotic activity a low sensitivity was found (33.3%). In only 7.6% of cases all criteria investigated (with the exception of the infiltration of adnexa) were simultaneously present. The three most sensitive criteria could be found in 46% of cases and two of these criteria in 88% of cases. In conclusion, this semiquantitative analysis of histologic criteria revealed that (1) thin malignant melanomas can be diagnosed with a few, but very sensitive, criteria and (2) the absence of criteria with minor sensitivity is not helpful for correct diagnosis.

[Lichen aureus zosteriformis]

A case of lichen aureus is presented, which is atypical in that a very large area was involved and there was a good response to topical fluorinated steroid therapy. Similarities to other cases reported in the literature are demonstrated.

Reactivity of T cells in mycosis fungoides exhibiting marked epidermotropism with the monoclonal antibody HML-1 that defines a membrane molecule on human mucosal lymphocytes

Twenty-eight cases of cutaneous T cell lymphomas of mycosis fungoides type, 8 of which showed a marked epidermotropism, were investigated for their reactivity with the monoclonal antibody HML-1. This reagent selectively recognizes human benign and malignant intestinal T lymphocytes, but not benign or malignant lymph node T cells. In all cases, the majority of nonepithelium-associated T cells present in the corium were HML-1 negative. In the eight cases with marked epidermotropism, the intraepidermal (IED) T cells were HML-1 positive in three cases, and HML-1 negative in the remaining five cases. The HML-1 positive IED T cells tended to be localized preferentially in the basal layers, whereas the HML-1 negative IED T cells were more diffusely distributed throughout all epidermal cell layers or formed intra-epidermal aggregates. These findings provide further evidence that mycosis fungoides is not a single entity, but represents a group of neoplasms originating from different T cell subsets that have in common their tropism to epidermis and/or dermis, and thus have a similar clinical presentation.

Tumor cell growth fractions in human malignant melanomas and the correlation to histopathologic tumor grading

The growth fraction (GF) of 72 human malignant melanomas was determined by immunostaining with monoclonal antibody Ki-67. A positive correlation of GF and histopathologically-assessed prognostic variables, such as tumor thickness, mitotic rate, and prognostic index, was found. Individual Ki-67 values were considerably scattered in all histologically defined groups of malignancy. Thus, GF as determined by Ki-67 was used to calculate a modified prognostic index. In contrast to the histologically defined prognostic index, the Ki-67 based prognostic index allows further subdivision of thin malignant melanomas with no or few mitotic figures. This may be of help in identifying tumors with a high recurrence potential.

[Lentigo of the glans penis]

The report deals with two male patients with penile lentigo. Histologically acanthosis, basal hyperpigmentation, and melanocytes without atypia were found. Ultrastructural analysis revealed the presence of single melanosomes within the keratinocytes as the most prominent feature of penile lentigo. In one patient, topical treatment with acelaic acid resulted in some improvement within 4 months.

[Acquired hyalinosis cutis et mucosae in plasmacytoma with monoclonal IgG-lambda gammopathy]

A 66-year-old female patient developed within 2 years clinical symptoms of hyalinosis cutis et mucosae due to a plasmocytoma with monoclonal IgG-light-chain gammopathy. The clinical diagnosis was supported by light- and electron-microscope studies. The form of hyalinosis cutis et mucosae described by Urbach and Wiethe is a genetic disease with its onset in early childhood. For this reason, we propose the designation "acquired hyalinosis cutis et mucosae" for the case reported here.

[Spindle cell lipoma]

A 74-year-old patient presenting with a subcutaneous tumor on his right upper arm is reported. Clinical examination led to the suspicion of a lipoma, cyst, and subcutaneous metastasis. Microscopical and immunohistological investigations allowed diagnosis of the tumor as a spindle cell lipoma. The most important aspect of differential diagnosis of this benign tumor is the exclusion of liposarcoma.

[The Brocq pseudopelade--a disease picture or disease entity]

In 1885 Brocq described a type of scarring alopecia he called pseudopelade (PPB), whose character as a separate disease entity has been denied in recent decades. Several authors now believe PPB to be a polyetiological final stage (état pseudopeladique de Degos; EPP). In all, 142 patients with scarring alopecia were analyzed in an attempt to find whether PPB is a separate entity or not. Following examination, 26 cases with lichen ruber (LR), 18 cases with lupus erythematosus chronicus discoides (DLE), 2 cases with scleroderma, 1 case with folliculitis decalvans, and 1 case with ichthyosis vulgaris were diagnosed; this left 94 cases with PPB (66%). We attempt to describe the macroscopic morphology and histopathology in PPB and in LR and DLE. The findings yielded by direct immunofluorescence and the treatment are discussed.

Association of early malignant melanoma with nevocytic nevi

The percentage of histologically associated malignant nevocytic nevi is essential for establishing concepts of histogenesis. The literature abounds with studies of this association. However, the results are conflicting and vary between 4% and 72% of malignant melanomas with associated nevocytic nevi with a maximum frequency between 20% and 30%. These different values could be partially explained by the fact that tumors in more advanced stages might have "overgrown" preexisting nevocytic cells. For this reason, only cases of early stage malignant melanoma (tumor thickness less than or equal to 1.5 mm; level of invasion less than or equal to III) were included in this study (n = 150). Thirty-three (22%) of 150 cases of malignant melanoma were associated with nevocytic nevi. In an additional 6.1% of the cases there was a possible but doubtful association. In 45.4% of the cases the nevus cells could be detected below the tumor, in 18.2% they could be seen at the laterally adjacent sides, and in 36.4% they were found at both sites. Fifty percent showed junctional activity from the nevocytic nevi located to the side of the melanoma. We conclude that the finding of approximately 27% of nevocytic nevi with junctional activity among the nevocytic nevi associated with malignant melanoma could be an indicator that at least some malignant melanomas develop within or next to a preexisting and still proliferating nevocytic nevus.

[Metabolism of drugs in the skin]

The principle metabolic pathways in the skin and their practical implications are still largely unknown. Some insight has already been gained from a few in vivo methods (application of radiolabelled substances in animal and man) and several in vitro methods (skin slice models, use of skin homogenates, skin perfusion models). Most of the drugs investigated with these methods have been glucocorticosteroids: cortisol (oxidation to cortisone, reduction at C-20 and delta 4), diflucortolonvalerate, fluocortinbutylester (ester cleavage). Estradiol (oxidation to estrone) and vidarabine-5-valerate (ester cleavage) are drugs of a different type that have been examined.

Keratinocytes in lesional skin of atopic eczema bear HLA-DR, CD1a and IgE molecules

Apparently normal, and lesional skin from patients with atopic eczema were investigated immunohistochemically with anti-HLA-DR, -CD1a and -IgE antisera. A CD1a+ intercellular pattern was observed in uninvolved skin in the majority of the patients whereas an HLA-DR+/CD1a+ network, mostly localized in basal and supra-basal areas, was shown in lesional skin of virtually all of them. Moreover, an HLA-DR+/CD1a+IgE+ intercellular pattern was observed in some of the patients only and was predominantly localized in those areas characterized by lymphocyte exocytosis, spongiosis or vesicle formation. Whether keratinocytes are able to synthesize CD1a antigen and Fc epsilon R or if these molecules are only produced and shed by CD1a+/IgE+ epidermal dendritic cells remains unclear.

Immunostaining in atypical fibroxanthoma of the skin

We have studied 12 cases of cutaneous atypical fibroxanthoma using immunohistochemistry to demonstrate lysozyme, alpha-1-antitrypsin, S-100-protein, receptors for peanut agglutinin, and intermediate filaments. Results were compared with immunostaining in 24 cases of other so-called fibrohistiocytic tumours. In addition 2 cases of atypical fibroxanthoma and 6 cases of fibrohistiocytic tumours were stained by monoclonal antibodies specific for the monocyte cell lineage (Ki-M1, Ki-M2, Ki-M6, Ki-M7, Ki-M8, OKM-1 and Leu-M1) and double-stained by monocyte-markers and Ki-67. The immunophenotype of atypical fibroxanthoma was rather similar to the marker profile found in malignant fibrous histiocytoma. All atypical fibroxanthomas were positive for vimentin and negative for epithelial markers. Monocyte lineage-specific determinants could be demonstrated in varying amounts in cells suggestive of being reactive. In contrast proliferating--Ki-67 positive--cells did not express monocyte/macrophage related antigens in atypical fibroxanthoma and malignant fibrous histiocytoma both. As to the histogenesis of these tumours our findings speak in favour of a derivation from primitive mesenchymal cells rather than from histiocytes.

[Epicutaneous testing with a standard series. Results in 12,026 patients]

From 1977 to 1983, 12,026 patients were given patch tests with a standard series of substances. A total of 4,494 (37.4%) had positive patch-test reactions to one or more allergens; the average number of positive reactions was 1.85. The most frequent reactions were due to nickel sulphate (positive reactions in 9.2% of those tested), fragrance mix (8.9%), balsam of Peru (6.3%), cobalt chloride (4.7%), potassium dichromate (4.3%) and wool alcohols (4.3%). Women showed significantly more positive reactions than men to nickel sulphate, cobalt chloride, wool alcohols, and parabens and significantly fewer positive reactions than men to potassium dichromate, PPD mix, and epoxy resin. Younger patients showed significant more positive reactions to nickel sulphate and cobalt chloride; middle-aged patients reacted more to potassium dichromate, paraphenylendiamine, formaldehyde and thiuram mix; elderly patients reacted to balsam of Peru, wool alcohols, caine mix, neomycin sulfate, benzocaine, colophony, clioquinol, mafenide, parabens, and gentamycin sulfate.

[The disease picture of verruciform xanthoma]

The case of a 39-year-old male patient is reported who had two filiform wartlike lesions at the vestibulum of the nose. Histologically, we found typical verruciform xanthomas with parahyperkeratosis, acanthosis, and central necrosis of epidermis, as well as multiple foam cells in the dermis.

Hemorrhagic bullous amyloidosis. A histologic, immunocytochemical, and ultrastructural study of two patients

In patients with bullous hemorrhagic amyloidosis of the skin, the skin lesions were the first manifestations of a plasma cell dyscrasia. Both cases were characterized by similar clinical, histologic, and ultrastructural findings showing an intradermal blister within deposits of amyloid substances. Immunohistologic investigations with a panel of antibodies directed against amyloid fibril proteins showed reactivity of the amyloid deposits with an anti-A lambda serum in both patients.

[Epithelium transplantation with cultivated keratinocytes]

Efforts for a skin substitute from cultured cells have been made since many years. Epidermal cells are able to proliferate in culture vessels under strictly defined culture conditions. The gained expanded epithelial layer can be used as transplant. The culture methods of Green and Eisinger are discussed. In the last couple of years in vitro expanded epithelium was used as wound coverage, especially for major burns. Autologous transplanted epithelium is accepted perfectly under optimal wound bed conditions. Reports on the acceptance of allogenic transplanted cultivated keratinocytes are contradictory, possibly so far unidentified antigens are responsible for the rejection. To optimize the skin substitute keratinocytes can be cultured on different mesenchymal substrates. Possibly epidermal appendages can be included in the future.

[Eruptive histiocytoma and xanthoma disseminatum as manifestations of the same disease?]

Xanthoma disseminatum, generalized eruptive histiocytoma, juvenile xanthogranuloma and Hand-Schüller-Christian disease are considered to be separate nosologic entities, but it can be difficult to differentiate them and establish the correct diagnosis in a given case. In this paper, the case of a young man is presented who showed lesions resembling those of generalized eruptive histiocytoma early in the course of disease while the lesions later showed typical signs of xanthoma disseminatum.

Lectin typing of Haemophilus ducreyi

The cell wall carbohydrates of 43 strains of Haemophilus ducreyi isolated in different parts of the world were subjected to lectin analysis using commercial panels containing 14 different plant lectins of known specificity. Preliminary evidence indicated both intrastrain and inter-strain variation in cell wall carbohydrate composition. In addition, it was possible to group strains from different geographical areas by lectin agglutination patterns. Lectin typing might thus become a useful marker system for epidemiological investigation of Haemophilus ducreyi infections.

[Microbial flora and odor of the healthy human skin]

The microflora resident on human skin shows great interindividual and intraindividual differences. It is essentially composed of micrococci, staphylococci, aerobic and anaerobic coryneforms as well as pityrosporum species which, in accordance with the different environment in the different regions of the body, are in a steady state. With increasing age, human skin microflora undergoes qualitative changes: the streptococci, which are found in infants, disappear and coryneform bacteria occur, which are mainly responsible for odor production. Anaerobic propionibacteria are more numerous in juveniles and young adults, a fact that may be explained by increased sebum production. Only the coryneform bacteria are able to produce the typical axillary odor by decomposition of apocrine sweat. Cocci, however, obviously do not have this capacity. It remains to be established which substances participate in odor production. With sensitive chromatographic methods amino acids, steroids and free fatty acids were detected, which could be related to body odor. There are possibly only a few commonly occurring odorous substances. The necessity of analyzing these substances is stressed.

[Pathomechanisms in Candida albicans infections]

The adherence of the pathogen to the host cell is the first and decisive step in Candida albicans infections of the human organism. The mechanisms involved are mostly examined in human epithelial cells which are newly exfoliated and which therefore have a limited life expectancy. In this case, the glycoproteins on the cell surface of Candida albicans--mainly the mannan--are of central importance. They are the main component of the fungus to adhere to the host cell as well as to bind and activate the serum complement. Finally, the role of mannan in the interaction with host defence mechanisms is stressed.

[Primary osteoma cutis]

Osteoma cutis is a rare tumour of the dermis which can only be diagnosed histologically. Pathogenetically, primary (neoplastic) and secondary (metaplastic) ossification must be differentiated. Primary ossification may lead to congenital osteomas and occurs in Albright's hereditary osteodystrophy and in Gardner's syndrome. Secondary, metaplastic ossification may be seen in association with cutaneous tumours, scars or inflammatory processes.

T4/T8 ratio and absolute T4 cell numbers in different clinical stages of Kaposi's sarcoma in AIDS

Thirty-seven men (36 homosexual or bisexual and one heterosexual) with epidemic Kaposi's sarcoma and underlying HIV infection were followed up over a period of up to 32 months. Fourteen patients (38%) died, with a median survival time of 7.2 months after the diagnosis of AIDS. Seventeen patients (46%) presented with one or more opportunistic infections, mostly Pneumocystis carinii pneumonia. Eighteen patients (49%) had lymphadenopathy syndrome according to the definition of the CDC. Using the Laubenstein-classification of Kaposi's sarcoma, all patients either remained stable or deteriorated, improvement was never observed. Absolute T4 lymphocyte counts and the T4/T8 ratio were not related to the disease stage. With the onset of B symptoms (systemic symptoms), however, the absolute T4 numbers and the T4/T8 ratio markedly decreased. Delayed type hypersensitivity also showed no relationship to the clinical stages of Kaposi's sarcoma. Thus, the clinical progression of Kaposi's sarcoma lesions seems to be largely independent of the immunological parameters investigated. However, the onset of B symptoms was observed to be related to changes in immune status.

[Angiosarcoma of the scalp]

A 57-year-old male patient suffering from angiosarcoma of the scalp is reported. The clinical picture was highly characteristic, showing an ulcerated reddish tumour without clear demarcation. However, the histological characterization was more difficult and a final diagnosis could only be established with immunohistochemistry using antibodies directed against several endothelial cell antigens.

[Condylomata acuminata gigantea (Buschke-Löwenstein tumor). Treatment with the CO2 laser and interferon]

CO2 laser resection of giant condylomata acuminata of the penis, histologically confirmed, was successfully achieved with excellent cosmetic results in a 58-year-old man, penis amputation having previously been advised. Postoperative recurrence has been prevented, for six months so far, with low-dose, systemic administration of alpha-2b interferon.

Antihuman T-cell leukemia/lymphoma virus antibodies in three patients with primary cutaneous B-cell lymphoma

In 3 patients suffering from follicular center-cell-derived B-cell lymphoma with primary cutaneous manifestation, antiadult T-cell leukemia-associated antigen antibodies were detected by the ELISA. In one of the patients, the husband and the dog had died from thymoma and from malignant lymphoma, respectively.

[Virus-specific antibody profile in various stages of HIV-1 infection. Western blot analysis of 170 patients]

The western blot analysis of 170 patients with HIV-1-infection demonstrated that 47% of the patients in latent stage, 58% of the patients with lymphadenopathy-syndrome and only 25% of the patients with the full-blown picture of AIDS showed the complete pattern of HIV-specific antibody response. This antibody response is mainly directed against the env-encoded envelope proteins gp160, gp120 and gp41, against the gag-encoded core proteins p55, p24 and p17 as well as against the pol-encoded enzymatic proteins p66, p51 and p31. Antibodies against gp160 and gp120 were present in nearly all patients, whereas the prevalence of the other antibodies decreased with the stage of the disease. Statistical significant differences were found particularly between patients with LAS or AIDS respectively. Antibodies against p17 were detected in 74% of the patients with LAS but only in 25% of the patients with AIDS. The lack of antibodies against p17, p24 or p51 was significantly associated with lower mean CD4/CD8-ratios (p less than 0.007) and higher mean serum levels of IgA (p less than 0.001) and beta-2-microglobulin (p less than 0.001). One third of the patients with LAS and this reduced pattern of antibody response developed AIDS within six months. These results demonstrate that the detection of antibodies against p17, p24 or p51 is of prognostic importance. A serological profile which lacks the antibody response against at least two of those three viral antigens indicates a progression of the disease activity.

[Antibodies against HTLV I in T-lymphoproliferative diseases of the skin]

The possibility that lymphoproliferative diseases may have a viral etiology has been discussed for many years. The first piece of evidence - in combination with convincing epidemiological data - was the detection of a virus of the HTLV group (HTLV I, ATLV) in patients with adult T-cell leukemia in Japan. There have been no comparable observations made in Europe. In 7 of 72 sera of patients with T-lymphoproliferative diseases in Central Europe, we were able to detect antibodies against HTLV I (ELISA and immunoblot), which might be an indication that retroviruses play a role in the etiology of these diseases.

Levels of type IV collagen and laminin fragments in serum from patients with progressive systemic sclerosis

Sera from patients with progressive systemic sclerosis (PSS) were studied using immuno-assays for laminin P1 fragment and the carboxyterminal NC1 domain from type IV collagen. Compared to healthy controls, patients with PSS showed elevated serum levels of both fragments derived from basement membrane proteins. However, there was no difference when patients with and without Raynaud's phenomenon were compared and no correlation could be established with the activity of the disease or clinically defined types of scleroderma. Our data indicate that the metabolism of basement membrane proteins is involved in the course of scleroderma; however, it remains questionable whether these assays could become useful as diagnostic or prognostic tools.