[The scientific development in dermatology in Germany in relation to the emigration of Jewish dermatologists during national socialism]

The anti-semitic laws let to the persecution of the Jews in Germany during the time of National Socialism. About 600 Jewish dermatologists had to suffer from the prohibition of their profession. 63% of them left Germany. The emigrants mainly preferred to move out to the U.S. The policy of coordination and elimination of the National Socialists led to the reappointment of dermatological chairs in universities. The National Socialists also forced the change in the boards of dermatological societies and the change of the editorial boards of dermatological journals. All papers of the three leading dermatological journals were analysed for the evaluation of the development of science. The assessment included the number of articles, the origin of the authors and the contents of articles (research, clinics, diagnostic, therapy). From 1933 to 1945 the number of papers per year decreased consequently, especially during the Second World War. During the whole time the number of German authors increased and the number of abroad living authors decreased. There was a very good and interesting international exchange of information in the journal "Archiv für Dermatologie und Syphilis". The activity reduced clearly after the beginning of the Second World War in 1939. The analysis of contents resulted in a reduction of basis science research and an orientation to the clinical research. Papers about therapeutical possibilities were always published. The emigration of Jewish dermatologists led to a continuous reduction of scientific activities and to an extensive international isolation.

Hormone-induced recruitment of Sp1 mediates estrogen activation of the rabbit uteroglobin gene in endometrial epithelium

Steroid hormones activate gene expression by interaction of their receptors with hormone-responsive DNA elements and tissue-specific or ubiquitous factors. To monitor the molecular changes on the promoter of the rabbit uteroglobin gene during early pseudopregnancy in vivo, we have applied the genomic footprinting methodology to endometrial tissue. Estrogen induction results in the simultaneous occupancy of an estrogen-responsive element and an adjacent GC/GT box in the promoter. DNA binding assays demonstrate that the corresponding regulatory factors are the ligand-induced estrogen receptor and the ubiquitous transcription factor Sp1. Both factors functionally synergize in primary endometrial cells, showing that the GC/GT box is an essential part of a composite estrogen-responsive unit. However, the estrogen receptor and Sp1 do not bind cooperatively to their sites in vitro, suggesting that other mechanisms might be responsible for the hormone-dependent binding of Sp1 in vivo. Since hormone treatment leads to the appearance of a distinct DNase I-hypersensitive site over the promoter chromatin, an estrogen-induced change in the local chromatin structure could facilitate binding of Sp1 in vivo.

[Suicide of dermatologists in relation to political change]

Anti-semitism increased from year to year in Nazi Germany from 1933 to 1945. The fear of annihilation resulted in a surge of suicides. The suicides of at least 9 Jewish dermatologists has been documented. Their mean age was 65 years. Couples often committed suicide together. At the end of World War II, the head of the dermatological department of the Prague University committed suicide. We assume the same happened in Rostock and Dresden. The president of the German Dermatological Society (DDG) committed suicide on March 27, 1945. The motives of these dermatologists were obviously the collapse of Nazism and the fear of relatiatory measures.

[Volumetric and morphological CT parameters for assessing prognosis and treatment control in hepatocellular carcinoma undergoing arterial chemoembolization]

PURPOSE

To evaluate volumetric CT data as a guide for indication and assessment of prognosis for transarterial chemo-embolisation (TAE) of hepatocellular carcinomas (HCC).

MATERIAL AND METHOD

74 patients with HCC were treated with repeated TAE. 50 mg Adriblastin/m2 body surface, 50 mg cisplatin/m2 body surface and 10 ml lipiodol were combined with 2-10 ml Spherex and injected selectively (25 cases) or superselectively (49 cases); in 28 patients a single injection and in 46 patients multiple injections were used.

RESULTS

CT findings before and after the procedure showed a solitary lesion in 17 patients, two lesions in 18 patients and in 39 patients there were three or more lesions. Mean expectation of life was 523 days (median = 372 days; 57% of one year survival probability). In 29 patients with > 75% lipiodol retention, mean survival was 819 days; in 17 patients with < 75% lipiodol retention it was 382 days; lower lipiodol retention of < 50% it was 231 days (< 25% 192 and < 10% 152 days). A statistically significant relationship (p < 0.0001) could be established between survival time and tumour volume, relationship of tumour to liver volume, intratumoral lipiodol retention, the type of tumour growth and the number of liver segments involved.

CONCLUSION

TAE provides best survival rates after repeated injections of solitary HCC with tumour volumes < 50 ml and > 75% intra-tumoral lipiodol retention.

Progestins prevent apoptosis in a rat endometrial cell line and increase the ratio of bcl-XL to bcl-XS

Endometrial cell proliferation and cell death are regulated by ovarian hormones. The fall of ovarian progesterone in late secretory phase, or the artificial withdrawal of ovarian hormones during early pregnancy, are followed by programmed cell death of uterine epithelial cells. Aspects of this cell-specific response have been reproduced in a newly established rat endometrial cell line which expresses functional progesterone receptor. At low concentrations of serum and in the absence of glucocorticoids, these cells were dependent on progestins for survival. Removal of progesterone or addition of the antiprogestins RU38486 or ZK98299 led to a substantial increase of apoptotic cells indicated by the accumulation of internucleosomally degraded DNA. The hormonal control of cell proliferation and cell death correlated with the overall quantity and distribution of the different bcl-X transcripts. Progesterone administration not only increased total bcl-X mRNA level but also shifted the quantitative ratio between the different mRNA isoforms in favor for the apoptosis inhibiting form, bcl-XL, compared with the apoptosis promoting form, bcl-XS. These effects were rapid and could not be prevented by inhibitors of protein synthesis. As the low level of bcl-2 and bax mRNA was not influenced by progesterone treatment, the observed changes in total amount of bcl-X transcripts and spliced isoforms could represent the mechanism by which progesterone controls cell death in epithelial cells of the endometrium.

[A simple method for improvement of the measurement of respiratory impedance in humans by increasing oropharyngeal impedance using cheek and mouth floor clamps]

It is known, that the upper airway (oropharyngeal) impedance (Z(op)) influences the measured input impedance of the respiratory system (Zrs). This investigation deals with simple methods reducing the artefact caused by Z(op). The following methods have been examined: (1) Supporting the cheeks with fingers, (2) supporting the cheeks and the floor of the mouth with fingers and (3) using a new mechanical clamp for the cheeks and the floor of the mouth. The effect of these procedures on Zrs, were investigated on two subjects. Also Z(op) has been estimated during a voluntary closure of the glottis (VALSALVA manoeuvre). The impedance has been assessed as well with forced sine shaped oscillations as with the pulsatile technique. All three procedures show, compared to measurements without any support, an increase of the Zrs, especially at high values. The highest increase has been obtained while using the clamp (up to 50%). The varied impedance must be placed in parallel to Zrs, because Z(op) increases even more than Zrs. So, by applying the clamp the subjects is better coupled to the measuring system. The clamp is easy to handle, leads to more exact values, and increases the inter- and intra-individual reproducibility.

Vasopressin and renin-angiotensin maintain arterial pressure during PEEP in nonexpanded, conscious dogs

Increases of plasma arginine vasopressin (AVP) and plasma renin activity (PRA) during controlled mechanical ventilation (CMV) with positive end-expiratory pressure (PEEP) induce positive fluid balances by decreasing renal excretion. We investigated whether elevated levels of AVP and/or PRA maintain mean arterial pressure (MAP) during PEEP under conditions where plasma volume is not expanded. Six conscious chronically tracheotomized beagle dogs, kept under standardized conditions, were investigated in four protocols. They were 1) control: 1 h spontaneous breathing with a continuous positive airway pressure of 4 cmH2O (CPAP 4) followed by 2 h CMV with PEEP, resulting in a mean airway pressure of approximately 20 cmH2O (CMV 20 referred to as "PEEP"); 2) vasopressin blockade: 1 h CPAP 4, 2 h PEEP after intravenous application of an AVP V1-receptor antagonist (AVPA); 3) converting enzyme inhibition: 1 h CPAP 4, 2 h PEEP plus angiotensin-converting enzyme inhibition (ACEI); and 4) combined blockade: 1 h CPAP 4, 2 h PEEP plus AVPA + ACEI. In AVPA + ACEI, MAP decreased during PEEP from 101 +/- 4 to 75 +/- 10 mmHg, glomerular filtration rate (GFR) decreased from 3.6 +/- 0.3 to 1.7 +/- 0.7 ml.min-1.kg body wt-1, heart rate increased from 95 +/- 10 to 122 +/- 7 beats/min, plasma aldosterone increased from 62 +/- 26 to 353 +/- 63 pg/ml, plasma epinephrine increased from 81 +/- 15 to 352 +/- 89 pg/ml (all changes P < 0.05), and plasma norepinephrine did not change. Neither MAP nor GFR changed during PEEP in control experiments in which both PRA and AVP increased, in AVPA experiments in which PRA increased, or in ACEI experiments in which AVP increased. We conclude that both AVP and angiotensin II contribute to the maintenance of MAP and GFR during PEEP. When both hormones are inhibited, no immediate compensation exists to prevent an acute fall in MAP and GFR.

Androgen-like and anti-androgen-like effects of antiprogestins in human mammary cancer cells

In addition to their antiprogestational activity, the antiprogestins RU486, ZK98.299 and ZK98.734 possess varying antiglucocorticoid as well as androgen-like or antiandrogen-like properties in human mammary cancer cells. The human mammary cancer cell line MFM-223, which contains only androgen receptors, was used as a model to investigate androgen receptor mediated effects of these antiprogestins. Proliferation of MFM-223 cells is inhibited by androgens and does not respond to oestrogens, progestins and glucocorticoids. As shown in proliferation assays, ZK98.734 was a strong inhibitor of cell proliferation. This effect was antagonised by the antiandrogen hydroxyflutamide. ZK98.734 was found to displace [3H]R1881 from the androgen receptor in MFM-223 cells, substantiating the involvement of the androgen receptor. The antiprogestin ZK98.299 failed to influence the proliferation of MFM-223 cells. ZK98.299 did not bind to the androgen receptor and was devoid of androgenic or antiandrogenic activity. RU486 bound to the androgen receptor. It was a weak inhibitor of MFM-223 cell proliferation, but the inhibition of proliferation by RU486 was not antagonised by hydroxyflutamide. This effect was probably not mediated by the androgen receptor. RU486 had antiandrogenic activity in this cell line, as it antagonised the inhibitory effect of dihydrotestosterone at a 100-molar excess. These results were confirmed by transfection experiments with an MMTV-CAT construct in the same cell line, demonstrating the biological function of the ZK98.734-androgen receptor complex. ZK98.299 and RU486 were not able to induce CAT activity. The different androgenic or antiandrogenic properties of the antiprogestins investigated should be considered when selecting antiprogestational properties of the antiprogestins investigated should be considered when selecting antiprogestational compounds for clinical applications, as a partial androgenic activity may be of benefit in breast cancer but can have undesired side-effects in other diseases.

[The scars of Andy Warhol]

The biographical and artistic documents describing to the attempted assassination of the artist Andy Warhol are reviewed. The visible scars are interpreted as symbols of the damaged integrity of the skin.

Biphasic pattern of gelsolin expression and variations in gelsolin-actin interactions during myogenesis

During myogenesis in vitro, the amount of gelsolin in myogenic cells increased by a factor of approximately 3 from about 200 ng to a maximum of 750 ng per milligram of total protein. Gelsolin increased steadily from the myoblast state to terminally differentiated myotubes containing abundant cross-striated myofibrils. At the same time, the amount of total actin varied by only about 30%, the molar ratio of gelsolin:actin increased from 1:500 to approximately 1:150. This modulation of gelsolin expression was observed both in avian and mammalian myocultures. Once the state of terminal differentiation in myocultures was attained, the amount of gelsolin decreased again. On the other hand, gelsolin decreased continuously in the postnatal mouse muscle by a factor of approximately 5 between Day 1 and Day 12 after birth. When myogenic cells from various stages of differentiation were extracted with Triton X-100, the majority of gelsolin was soluble, whereas a minor fraction was tightly associated with the cytoskeleton. The actual amount of insoluble gelsolin depended on both the Ca2+ concentration during extraction and the degree of differentiation. Whereas at [Ca2+] > 10(-5) M about one-third of the total gelsolin was associated with the cytoskeleton at all stages of differentiation, the amount of insoluble gelsolin after Triton extraction in the presence of EGTA increased from 3 to 17% during differentiation. The amount of soluble actin decreased from 40 to 25% during the same period, independent of the Ca2+ concentration. We calculated that the amount of gelsolin associated with the cytoskeletal or myofibrillar system is approximately 20-fold higher in differentiated myotubes than in early myotubes, indicating a functional role of gelsolin for myofibrillar assembly.

[Dresden dermatology--an example?]

Since the first dermatological outpatient clinic was started in Dresden in 1869, it has seen the practice of dermatology in the broadest sense, with scientific research activity and innovation. The good working relationship between the dermatologists in private practice and those in the clinics has been the main factor in this successful development. The traditional background of the following sectors is highlighted: outpatient clinic, X-ray and UV light treatment, allergology and occupational dermatology, psychosomatic dermatology, dermatosurgery, and phlebology.

Successful outcome of cryosurgery in patients with granuloma annulare

Several therapeutic methods have been employed in the management of localized granuloma annulare (GA), with varying degrees of success. We performed a prospective trial to evaluate the efficacy, cosmetic results, and safety of cryosurgical treatment in GA. Thirty-one patients with localized GA were treated by cryosurgery, using the contact method. Nitrous oxide (-86 degrees C) or liquid nitrogen (-196 degrees C) were used as refrigerants, and were applied with closed probes; each lesion was treated with one freeze-thaw cycle of 10-60 s per session. If necessary, treatment was repeated after 20-30 days. Resolution of the lesions was obtained in all patients, and in 25 of 31 patients (80.6%) they resolved after a single freeze-thaw cycle. Relapse occurred in only one of 11 patients who were followed for more than 2 years, and this occurred 16 months after treatment. Excellent cosmetic results were obtained in 14 of 28 patients who were eligible for evaluation (50%), and good results in 11 (39.3%). The cosmetic result obtained by cryosurgery with nitrous oxide was independent of the size of the lesion, whereas in the group of patients treated with liquid nitrogen a better cosmetic result was obtained with smaller lesions (comparison of lesions < or = 2.40 cm2 with those > 2.40 cm2; P = 0.04). The duration of the lesion, its location, previous treatment with another method, and the number of treatment sessions, did not have any influence on the cosmetic result. The treatment was generally well tolerated. Blister formation occurred in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quality criteria of digital subtraction angiography of the trunk of the body]

The presently valid quality criteria of digital subtraction angiography in the body trunk area are described. The indications for intravenous and intraarterial examinations are explained; these are closely connected with the respective demands. The problem levels are analysed and update technical and methodical solutions are offered.

Resetting of 24-h sodium and water balance during 4 days of servo-controlled reduction of renal perfusion pressure

This study examines whether an increase in renal perfusion pressure (RPP) is necessary to escape endogenously stimulated Na- and water-retaining mechanisms. In seven dogs stimulation was accomplished by a servo-controlled reduction of RPP (rRPP) below the threshold for pressure-dependent renin release for 4 days. Oral intake was standardized. Plasma renin activity (PRA) rose from 2.5 in controls to approximately 5 ng ANG I.ml-1 x h-1 during rRPP days. Plasma aldosterone concentration (PAC) increased by approximately 50% only on day 1 of rRPP but fell at or below control levels thereafter. The PAC-to-PRA ratio decreased during rRPP days. Atrial natriuretic factor (ANF) rose to values three times higher than in controls. Mean systemic blood pressure (MABP) rose from 111 +/- 12 in controls to 142 +/- 14 mmHg on day 4 of rRPP. On day 1 of rRPP 60% of the Na and 24% of the water intake were retained. However, after 2-3 days the input-output balance was restored but on a higher level of total body Na and total body water (new "set point"). Because elevated systemic MABP could not exert direct pressure effects on the kidneys due to servo control of rRPP, there must be other factors, e.g., fall in PAC, increase in ANF, and changes in intrarenal hemodynamics and physical factors that may have contributed to the resetting of input-output balances during rRPP.

Differentiation of benign prostatic hyperplasia and prostate cancer employing prostatic-specific antigen density

To enhance the ability of prostate-specific antigen (PSA) to distinguish benign prostatic hyperplasia (BPH) from cancer of the prostate (CaP) Benson et al. defined a new parameter, PSA density (PSAD), which is the ratio of the serum PSA concentration to the volume of the prostate. We have employed this parameter in a prospective study of 28 patients with clinically localised CaP and 57 patients with BPH. Mean PSAD was 0.116 for the BPH patients and 0.46 for the CaP patients (p < 0.005). The authors conclude that the information provided by PSAD is superior to absolute PSA values in the differentiation between BPH and CaP.

[Initial experiences with combined balloon angioplasty and rtPA thrombolysis in dialysis shunt failure]

The 23 interventions performed by us on 18 patients had a very high success rate both in intraarterial lysis therapy of obstructed haemodialysis shunts and in balloon angioplasty (19/23). Shunt failure had to be primarily treated by surgery in 3 cases only. The complications were confined to a rupture of a vessel that required surgical care. 14 shunts were found to be patent in a total of 18 patients (18 being of course as small patient group). Our experience leads us to believe that patients suffering from shunt insufficiency should always be primarily treated endoluminally if angiography confirms that intervention is possible. Surgical intervention is always advisable even if the result may occasionally be negative in a few rare cases.

[Primary femoral recanalization using a slowly rotating catheter system]

Over a period of 2 years, 26 patients with chronic occlusions of the superior femoral and popliteal arteries were referred for recanalization. In two cases, the origin of the superior femoral artery could not be detected. A primary recanalization was achieved in 21 of 24 patients by the catheter system used by us (Viadyn). A stent (extensor) had to be implanted in one case because of a considerable lesion of the intima. A short-term clot lysis was indicated for another patient. On the basis of our results, rotation angioplasty with a slowly rotating catheter system seems to be the therapeutic method of choice for chronic arterial occlusions in the thigh.

Ion channels in human axons

1. Until now, no direct electrophysiological information has been available on the molecular basis of human nerve excitability. We here report patch-clamp recordings, both single- and multichannel, from acutely dissociated human axons. 2. Voltage-dependent sodium channels with a conductance gamma = 13 pS (measured in Ringer at room temperature) are found in the nodal area. 3. There are several types of voltage-dependent potassium channels: I channels (gamma = 34 pS), F channels (gamma = 50 pS), and channels with small conductance (gamma = 7-9 pS, all measured in high potassium solution). Most of them are closely similar to those already reported in Xenopus and rat axons; in addition a 200-pS, calcium-dependent potassium channel, similar to that in Xenopus, is present. 4. Differences between the electrical behavior of human axons and those of other species are probably not due to the presence of fundamentally different channel types, but may be due to differences in channel density or distribution. 5. As well as increasing our understanding of the basis of excitability in human nerve, this method may prove useful in the investigation of inherited and other human neuropathies.

Femoral head perfusion in patients with femoral neck fracture and femoral head necrosis

Femoral head perfusion in adults was studied by superselective i.a. DSA in 35 normal subjects, in 9 patients with medial femoral neck fracture preoperatively, and in 36 patients with femoral head necrosis before bone grafting, and as therapeutic control after grafting. All patients with femoral neck fracture showed an interruption of the proximal nutrient branches. In 93% of the cases with femoral head necrosis, these branches were rarefied or the medial circumflex femoral artery was interrupted. Postoperative DSA after pedicled pelvic bone graft revealed a regularly perfused graft in 82%. Superselective i.a. DSA is a valuable procedure for the therapeutic decision in selected patients with femoral neck fracture as well as before pedicled pelvic bone grafting and as therapeutic control after grafting.

Contrast-enhanced transcranial Doppler US with a new transpulmonary echo contrast agent based on saccharide microparticles

The purpose of this first patient study (phase II) was to evaluate the clinical usefulness of a new echo contrast agent at transcranial Doppler ultrasonography (US). Twenty patients were selected from a group of 242 patients undergoing conventional transcranial Doppler US who had low (n = 18) or absent (n = 2) Doppler signals from the middle cerebral artery (MCA). The extent and duration of Doppler signal increase was measured in 30 MCAs and in 14 basilar arteries following the intravenous injection of a transpulmonary galactose microparticle suspension (SH U 508 A) at three concentrations (200, 300, and 400 mg/mL). Doppler waveform analysis became possible in 93% (28 of 30) of the MCAs following injection. The maximal increase in average Doppler signal intensity (11 dB at 200 mg/mL, 15 dB at 300 mg/mL, and 17 dB at 400 mg/mL) and the increase in average duration of the signal enhancement (163 seconds at 200 mg/mL, 219 seconds at 300 mg/mL, and 240 seconds at 400 mg/mL) depended on contrast agent concentration. Doppler waveform analysis became possible in 79% (11 of 14) of the basilar arteries. The intravenous injection of this new echo contrast agent markedly increases Doppler signal intensity in patients with nondiagnostic results at conventional Doppler US.