Uptake of amino acids by brain microvessels isolated from rats after portacaval anastomosis

The uptake of amino acids by microvessels isolated from brains of rats was studied. Previous studies have demonstrated alterations in blood-brain amino acid transport after portacaval shunt in rats. In order to elucidate whether such changes in the blood-brain barrier were located in the microvessels, brain microvessels were isolated from both rats with portacaval shunt and controls. Brain microvessels from rats 2 weeks after shunt operations took up significantly greater amounts of 14C-labeled neutral amino acids, but not of glutamic acid, lysine, or alpha-methylaminoisobutyric acid than microvessels from sham-operated controls. Measurement of uptake kinetics showed a higher Vmax for phenylalanine and leucine uptake and a lower Vmax for lysine uptake in microvessels from shunted rats compared with control, whereas the respective Km's of uptake were similar in both preparations. The results suggest that changes in brain microvessel transport activity account for altered brain neutral amino acid concentrations after portacaval shunt and that such changes can be studied in vitro in isolated microvessels.

Long-term photochemotherapy: histopathological and immunofluorescence observations in 243 patients

Skin biopsies of 243 patients treated with photochemotherapy (PUVA) for 1--4 years were examined histologically. Two hundred and six patients were examined retrospectively after total cumulative UV-A doses of 579 . 6 +/- 598 . 0 J/cm2 (mean +/- s.d.). An eosinophilic homogenization and a reduction of elastic fibres at the dermo--epidermal junction, and an increase of dermal macrophages were found as possible abnormalities. However, except for the increase of melanophages there was no statistically significant correlation between the incidence of these changes, the total UV-A dose applied and the skin type of the patients. Neither were such correlations found in thirty-seven patients biopsies twice after 394 . 8 +/- 267 . 6 J/cm2 and 808 . 5 +/- 458 . 9 J/cm2 (mean +/- s.d.), respectively. Studies with direct immunofluorescence techniques revealed no immunoglobulin deposits in PUVA treated skin in fifty-six patients after 469 . 2 +/- 370 . 2 J/cm2; antinuclear antibodies were observed in 4 . 6% of 129 patients after 169 J/cm2 (mean); in 11% of fifty-three patients reexamined after 381 J/cm2 (mean) and in 13 . 6% of twenty-two patients reexamined a second time after 643 J/cm2 (mean). Thirteen out of a total of 572 patients developed a peculiar mottling of skin in areas previously overdosed by PUVA. Subepidermal homogenization and reduction of elastic fibres were found in 45% of the patients, indicating that these changes indeed are a consequence of PUVA. Nuclear and cellular irregularities were found in 45% of the biopsies and 63% showed a disturbed epidermal architecture, but no carcinomas were observed. PUVA-induced mottling was reversible in 31%, partially reversible in 15%, but continued to be present in 54%.

Ultrastructural and immunological findings in Graves' disease with pretibial myxedema

This is a report on a 67-year-old female patient with Graves' disease and extensive pretibial myxedema. Linear IgM deposits were observed in the basement membrane zone by direct immunofluorescence. These deposits were found, by immunoelectron microscopy, to be haphazardly distributed in the uppermost dermis without any correlation to preexisting structures. An amorphous material that coated not only the surface of fibroblasts and collagen bundles but was also present within the dilated endoplasmic reticulum of the fibroblasts was the predominating pathological finding at the ultrastructural level. Mast cells were morphologically normal. These results support previous in vivo and recent in vitro findings indicating that the fibroblast plays a major role in the pathogenesis of pretibial myxedema.

Plasma amino acid analysis in the differential diagnosis of jaundice

Distinguishing between obstructive (surgical) and hepatocellular (medical) jaundice is sometimes impossible using the relatively simple diagnostic means of history, physical examination and liver function tests. In an attempt to reduce the number of jaundiced patients in need of complex and expensive diagnostic procedures, we investigated the use of the plasma amino acid pattern in the diagnosis of jaundice. Jaundiced rats with galactosamine-induced hepatitis and seven patients with acute onset hepatitis presented a plasma amino acid pattern in which most all amino acid levels were elevated except for arginine in the rat and branched chain amino acids in the patients. Rats jaundiced due to common bile duct ligation and seven patients with obstructive jaundice proved at surgery exhibited a near-normal amino acid pattern. These experimental and clinical data demonstrate very clear qualitative and quantitative differences in plasma amino acid patterns of hepatocellular and obstructive jaundice, with the latter exhibiting an almost-normal pattern. We suggest the use of the plasma amino acid pattern as a useful adjunct in the differential diagnosis of medical and surgical jaundice.

[Photoprotection by psoralen-UVA therapy: experimental and clinical results (author's transl)]

Studies on minimum erythema doses, histological investigations and quantitative determination of DNA repair synthesis of epidermal cells revealed that a tan induced by the oral administration of 8-methoxy-psoralen (8-MOP) and subsequent UVA irradiation gives protection from the erythemogenic effects of sunlight, diminishes UVA-induced cellular injury in the epidermis and, possibly, also shields DNA from incident UV radiation. In a study of 14 patients with severe polymorphous light dermatosis the 8-MOP-UVA induced tan proved to be a clinically effective sunscreen. The uncontrolled use of this method for UV protection of normal individual is, however, not recommended.

Kinetics of epidermal Langerhans cells

Langerhans cells are considered to play an important role in the initiation of the immune response. This study was performed in order to analyze the kinetics of the Langerhans cell population under different experimental conditions. Using tritiated thymidine, the number of labeled Langerhans cells (demonstrated by the Leucinaminopeptidase reaction), and of labeled basal keratinocytes was investigated by autoradiography in guinea pig skin in vivo, before and 2, 5 and 8 days after stripping and before and 2, 5 and 8 days after initiation of repeated topical exposures to a 0.25% solution of dinitrochlorobenzene (DNCB). In addition the total number of Langerhans cells per mm2 was determined before and after DNCB treatment of epidermal guinea pig sheet preparations using the ATPase reaction. A total of more than 100,000 cell as of basal keratinocytes was stimulated significantly (by statistical analysis), both by stripping and by application of DNCB. After stripping, however, the increase of the Langerhans cell turnover was found to be secondary to the turnover of basal keratinocytes, whereas after DNCB application the increase in the proliferative activity of Langerhans cells appeared as the primary event in epidermal cellular kinetics.

[Diagnosis of lupus erythematosus]

For the exact classification of lupus erythematosus, morphological criteria alone (clinical picture, histopathology, immunopathology from involved skin, immunoelectron microscopy) are not sufficient. It is the aim of this paper to discuss briefly the known criteria for the diagnosis of systemic lupus erythematosus with particular reference to the interpretation of more recent deagnostic methods (determination of certain antinuclear antibodies; lupus band test; C1q-binding assay.

[Ataxia telangiectasia (Louis-Bar syndrome)]

Ataxia telangiectasia (Louis-Bar syndrome) represents a disease of childhood, characterized by diffuse telangiectasia of the skin and the conjunctivae and cerebellar ataxia. Patients are frequently predisposed for infections due to disturbances of the cellular and humoral immunity. This paper discusses the syndrome referring to an own observation of ataxia telangiectasia and literature of the past.

5-Methoxypsoralen (Bergapten) in photochemotherapy of psoriasis

5-Methoxypsoralen (5-MOP, Bergapten) was evaluated as a potential photosensitizing drug in oral photochemotherapy of psoriasis. Treatment results indicate that (1) 5-MOP is as effective as, and in high doses more effective than, 8-methoxypsoralen in clearing psoriatic lesions; (2) therapeutic doses of 5-MOP do not lead to erythema; the acute side-effects of 8-MOP PUVA therapy--erythema, blistering, pruritus--are thus avoided; (3) even high doses of 5-MOP are not followed by nausea. 5-MOP PUVA therapy thus represents a real alternative to 8-MOP PUVA, its advantages over 8-MOP PUVA being greater safety and patient acceptance.

Decreased DNA repair activity in sunburn cells. A possible pathogenetic factor of the epidermal sunburn reaction

The pathogenesis of the formation of sunburn cells is unknown. Based on autoradiographic methods the unscheduled DNA repair synthesis of UV-induced thymin dimers was investigated in vivo in sunburn cells and in irradiated but histologically normal stratum spinosum cells. The results show a significant lower number of sparsly labeled cells in the sunburn cell-population (13.2 +/- 2.5; mean) when compared to the population of normal stratum spinosum cells (57.8 +/- 7.5; mean). These data indicate that the population of those epidermal cells, which become manifest as sunburn cells 24 h after UV exposure exhibit a reduced DNA repair of UV induced thymine dimers immediately after UV irradiation. Nuclear factors thus seem to play at least some role in the origin of sunburn cells.

PUVA suppresses the proliferative stimulus produced by stripping on hairless mice

Hairless mice were fed with 8-methoxypsoralen by gastric tube and exposed to UVA light to produce threshold phototoxic reactions. 3H-thymidine autoradiography revealed no significant difference of the epidermal labelling index as compared to that of nonirradiated animals (4.8 vs 6.2). Single PUVA exposures performed 2,8,14 and 24 hr after tape stripping lead to suppression of a wave of synchronized DNA synthesis present in nonirradiated control animals. These data demonstrate different reactions of stripped and unstripped epidermis to PUVA exposures and offer indirect evidence for the suppression of DNA synthesis in hyperproliferative skin disorders by PUVA in vivo.

[HLA B13, B17, B37 and Cw6 in psoriasis vulgaris: relationship to age of onset (author's transl)]

The frequency of HLA B13, B17, B37 and Cw6 was investigated in 77 patients with psoriasis vulgaris (57 patients with an onset of the disease between 10 and 20 years of age and 20 patients with an onset between 35 and 45 years). A highly significant increase in the frequency of the four HLA antigens tested was found. The highest relative risk was calculated for Cw6 (RR = 8.28). Furthermore, a significant positive association was observed between the presence of Cw6 and an early onset of psoriasis vulgaris.

Coincidence of vitiligo, alopecia areata, onychodystrophy, localized scleroderma and lichen planus

The unique coincidence of five dermatological disorders, which occurred in a 39-year-old patient, is discussed. The clinical and laboratory examination did not reveal a common underlying cause. It is hoped this report will stimulate the recognition of other cases and thus aid in determining whether the coincidence of these disorders is a true association of diseases with a common underlying factor or a rare abnormality.

Photoprotective effect of a psoralen-UVA-induced tan

To determine whether a tan produced by 8-MOP and UVA protects from subsequent solar light irradiation, volunteers were irradiated with unfiltered Xenon arc light before and 10 days after a 1 week's course of four 8-MOP-UVA treatments. Evaluation of the minimal erythema doses and of histological changes before and after 8-MOP-UVA treatment revealed that the 8-MOP-UVA induced tan protected against the erythemogenic and cell damaging effects of Xenon arc light. Unscheduled repair DNA synthesis, used as a measure for UVB-induced DNA damage and repair, was also investigated in skin irradiated with the Xenon arc before and after 8-MOP-UVA induced tanning. Both the number of grains per sparse labeled cell and the number of sparse labeled cells per 1000 cells, were found to be significantly lower in tanned skin; taking decreased unschedules repair DNA synthesis as a measure for decreased DNA-damage, these findings also demonstrate a photoprotective effect of the 8--MOP-UVA induced tan.

[The testing of photochemotherapy in various dermatoses]

Experimental PUVA therapy in five different skin diseases showed excellent results in lichen planus and pityriasis lichenoides et varioliformis. Present experience indicates a favourable influence of PUVA also in pityriasis rubra pilaris and in lymphomatoid papulosis. In Darier's disease PUVA leads to acute exacerbation.

Non-inflammatory dermal elastolysis

A 33-year-old woman is described who suffers from an idiopathic loss of mid-dermal elastic tissue which leads to wrinkling of the skin and to discrete perifollicular protrusions. In accordance with Sheley & Wood (1977) we conclude that these findings represent a new entity for which we propose the term 'non-inflammatory dermal elastolysis'.

Induction of UV light tolerance by PUVA in patients with polymorphous light eruption

A tan induced by 8-methoxypsoralen-long wave ultraviolet light has proved an effective photoprotective sunscreen in 5 patients with long wave ultraviolet light-induced polymorphic light eruption.

[Hyalinosis cutis et mucosae Urbach-Wiethe]

This report deals with the description of a typical case of hyalinosis cutis et mucosae Urbach-Wiethe and with the clinical and histological differential diagnosis to erythropoetic protoporphyria.

Serum uric acid levels in untreated and PUVA-treated patients with psoriasis

Hyperuricemia occurs frequently in patients with psoriasis. An increased purin breakdown due to the enhanced epidermal turnover was stressed as a reasonable explanation. To prove this theory serum uric acid, cholesterol, triglyceride levels and the average body overweight were determined in 318 untreated psoriatic patients and the parameters were correlated with the extent of psoriatic skin involvement. In more than 100 psoriatic patients treated by oral photochemotherapy (PUVA), uric acid serum levels were examined additionally after the PUVA clearing phase and during PUVA maintenance treatment. The present study demonstrates: (1) There is no relationship between the frequency of hyperuricemia and the extent of psoriatic skin involvement, indicating that the increased epidermal turn over may not play a role in psoriatic hyperuricemia. (2) The most reasonable explanation for elevated uric acid in psoriasis seems to be a combination of genetic predisposition and hyperalimentation. (3) No significant change was found in the incidence of hyperuricemia under the influence of photochemotherapy.

Severe viral pneumonia in young adults

Three patients with primary group-A influenzal pneumonia had diffuse pulmonary infiltrates, arterial oxygen tensions (PaO2) less than 50 mm Hg while breathing oxygen at 1 atm (fractional concentration of oxygen in the inspired gas (FIo2) equals 1.0), and right-to-left pulmonary shunts greater than 45 percent of total pulmonary blood flow. At an FIo2 of 1.0, end-expiratory pressure (EEP) was added in increments of 2 to 5 cm H2O every 30 to 60 minutes until the PaO2 was above 200 mm Hg and right-to-left shunting had fallen to less than 25 percent. The FIo2 was then lowered to 0.5. Using this systematic approach, all three patients required an FIo2 of 1.0 for less than 12 hours, minimizing the risk of oxygen toxicity. Two of the three patients did not require mechanical ventilation and breathed spontaneously while on continuous positive airway pressure (CPAP), and one of them tolerated an EEP of 31 cm H2O. Two patients survived, and one died of a neurologic complication of cardiopulmonary arrest, despite clearing on the chest x-ray film and improved gas exchange. Therapy with CPAP can be safely used in adults and has practical as well as theoretic benefits over continuous positive-pressure ventilation.

Dermatofibrosarcoma protuberans metastatic to a regional lymph node. Report of a case and review

A case of dermatofibrosarcoma protuberans of the lower extremity with metastasis to an inguinal lymph node appearing 5 years after wide excision and skin grafting of the primary lesion is presented. The world literature is reviewed. This case is the 24th instance of metastasis and the 7th case of lymphatic metastasis. The other 17 cases were hematogenous metastases. The clinical and pathologic features of dermatofibrosarcoma protuberans are reviewed, and treatment is discussed, with the aim of emphasizing the need for long-term followup examination of the regional lymph nodes following wide and deep local excision.