Acne fulminans: explosive systemic form of acne

Acne fulminans (AF) is a rare severe form of acne vulgaris associated with systemic symptoms. It primarily affects male adolescents. Although the aetiology of AF remains unknown, many theories have been advanced to explain it. There have been reported associations with increased androgens, autoimmune complex disease and genetic pre-disposition. The disease is destructive, with the acute onset of painful, ulcerative nodules on the face, chest and back. The associated systemic manifestations such as fever, weight loss and musculoskeletal pain are usually present at the onset. The patients are febrile, with leucocytosis and an increased erythrocyte sedimentation rate. They may require several weeks of hospitalization. The treatment of AF has been challenging; the response to traditional acne therapies is poor. The recommended treatment is aggressive and consists of a combination of oral steroids and isotretinoin. To avoid the relapses, duration of such treatment should not be less than 3-5 months. Although the prognosis for patients treated appropriately is good, these acute inflammatory nodules often heal with residual scarring.

[Evaluation of glucose, insulin, C-peptide uric acid serum levels in patients with psoriasis]

The aim of our study was to estimate the serum levels of glucose, insulin, C-peptide and uric acid in patients with psoriasis before and after treatment. The study included 12 males with active form of psoriasis and 15 control subjects carefully matched to the psoriatic patients for age and BMI. All measured parameters were in patients with psoriasis significantly increased and dependent on the BMI. Compared with pretreatment values of glucose and uric acid were significantly lower during therapy. The increase in the mean C-peptide and insulin levels after psoriasis therapy was constant and independent from clinical stage of disease. The results of the present study have provided evidence for the importance of impaired glucose and purine metabolism in patients with psoriasis in the increase risk of development of diabetes mellitus and hypertension.

Visual evoked potentials in patients with psoriasis vulgaris

PURPOSE

The aim of this study is an estimation of the visual evoked potentials (VEP) in patients with psoriasis vulgaris. The role of the nervous system was pointed out in the pathogenesis of psoriasis. Also epidemiologic research confirms that patients with psoriasis are at increased risk of MS development.

MATERIALS AND METHODS

A group of 30 psoriatic males aged between 18 and 54 was examined. The results were compared with those obtained from a group of 30 healthy age-matched males and they were correlated with the psoriasis area and severity index (PASI), the skin surface area involved, duration of the disease and duration of the last relapse. In neurological and ophthalmological examinations no pathological symptoms were detected in either group. The VEP examination was executed using pattern reversal (pr) and pattern flash (pf) stimulation.

RESULTS

Using pf stimulation, in the group of patients with psoriasis vulgaris, a statistically significant elongation in the latency of P-100 and reduction of response amplitude, not related to the PASI, nor the skin surface area involved, nor duration of the last relapse, were observed.

CONCLUSIONS

The results of the study indicate subclinical damage of the visual pathway in patients with psoriasis vulgaris.

The pattern and level of cytokines secreted by Th1 and Th2 lymphocytes of syphilitic patients correlate to the progression of the disease

The results of our previous work indicated that cell-mediated immune response, of importance in protection against Treponema pallidum, is distinctly inhibited at certain periods of syphilitic infection. Considering that cytokines, produced by Th1 lymphocytes, take part in this response and that their secretion may be regulated by cytokines of Th2 lymphocytes, we examined if, and in which stages of syphilis, such a regulation may exist. In this study we have examined the ability of cells to produce IL-2, IFN and TNF (Th1 or Th1 like cytokines) as well as IL-6 and IL-10 (Th2 or Th2 like cytokines). It was found that cells of syphilitic patients were able to produce IL-2, IFN, TNF, IL-10 and weakly IL-6 already in primary seronegative syphilis. At the same stage of syphilis, but seropositive, ability of Th1 lymphocytes to produce cytokines reached the highest values, whereas the cells producing IL-10 lost this ability. The cells producing IL-6 and MIF had the highest ability in secondary early syphilis. In this stage of syphilis again slightly increased the ability of cells to secrete IL-10, which reached the highest value in early latent syphilis. The growing ability to produce IL-6 and IL-10 was accompanied with a diminished production of IL-2, IFN and TNF nearly in all stages of syphilis. Only MIF, in contrast to other cytokines, was produced in late syphilis without distinct changes. The greatest suppression of Th1 lymphocytes to produce cytokines and cells to secretion of MIF was found in early latent syphilis when the level of IL-10 in cell culture supernates was the highest. High ability of Th2 lymphocytes to cytokines secretion in late syphilis and low ability of Th1 ones, which are very important for cell-mediated immune response, may be the reason for facilitating T. pallidum multiplication and development of latent stages of disease despite presence of immunologically competent cells.

[Function of peripheral airways in children and adolescents with deformities of the anterior chest wall]

Body-plethysmography and spirometric test were carried out in two groups of 33 children aged 7-16. Examined group consisted of 11 children with deformities of rib chest wall, and control group consisted of 22 healthy children. Pulmonary function test were performed in all subjects. They comprised spirometric parameters (FVC, FEV1, ITGV, RV, TLC) flow-volume curve parameters (PEF, FEF25, FEF50, FEF75) and airway resistance R(aw). Values of FEV1, FEF25, FEF50, FEF75 PEF and MMEF were significantly lower in the tested group than in the control group. In children with deformities of rib chest wall values of airway resistance were significantly higher, R(aw)--268%N, than in healthy children, R(aw)--188.5%N (p < 0.01).

[Development of ulcerative colitis in a male patient during exacerbation of Reiter's syndrome symptoms]

Three years observation of a male patient was presented, who manifested Reiter's syndrome with two relapses of the disease, associated with the typical triad of symptoms (acute arthritis, conjunctivitis, urethritis). Both relapses were accompanied by diarrhoea. In course the first relapse skin lesions were observed on both shanks, diagnosed as erythema nodosum. Complex studies on diarrhoea, performed during the first relapse, failed to doxycyclin and diclofenac. During the second relapse of Reiter's syndrome the diarrhoea was diagnosed to result from co-existing colitis ulcerosa. Serum titers of Chlamydia trachomatis antibodies were low during relapse, increased during patient's recovery and persisted at the high during asymptomatic period. High titers of such antibodies were noted also in the serum of the patient's wife in whom neither anamnesis nor physical examination could demonstrate any pathology.

The ability of peripheral blood mononuclear cells (PBMC) of syphilitic patients to produce IL-2

The cell-mediated immune response of importance in protection against Treponema pallidum, is distinctly suppressed in some stages of the disease. This may be a result of decreased ability of cells to produce IL-2, or IL-2 absorption by different factors. The experiments were designed to evaluate the ability of peripheral blood mononuclear cells (PBMC) of patients with different stages of syphilis to produce IL-2, and to investigate the causes which could possibly limit its activity. The ability of the PBMC of syphilitic patients to produce IL-2 develops at the beginning of the disease, reaching a maximum in primary seropositive syphilis. In the next stages of the disease this capability is distinctly lowered. The lowest was in malignant syphilis and tabes dorsalis, i.e. during severe disease. Absorption of adherent cells from PBMC increased the ability of lymphocytes to produce IL-2. The highest level of this interleukin was observed at the stages of the disease where suppression was the deepest. Sera of both control and syphilitic patients contained IL-2 inhibitor. Its level was the highest in early and late latent syphilis where no symptoms of disease were present. In all syphilitic sera a distinctly elevated level of soluble IL-2 receptors (sIL-2R) was also found. Its high level was noted in sera of patients in which PBMC had the weakest ability to produce IL-2. These findings suggest that sIL-2R may be bound to IL-2 and in this way would lead to weakening of T cell function and of resistance against Treponema pallidum infection.

The ability of peripheral blood mononuclear cells of rabbits infected with Treponema pallidum to produce IL-2

It was previously found that the cell-mediated immune response involved in protection against Treponema pallidum is distinctly suppressed during some periods in the course of syphilis infection in rabbits. This may be a result of the weak ability of cells to produce Interleukin-2 (IL-2) as well as of IL-2 absorption. The ability of peripheral blood mononuclear cells (PBMC) of syphilitic rabbits to produce IL-2 develops within the first two weeks after infection reaching a maximum in about the eleventh week. In infection of longer duration, this capability was distinctly lowered. This low level of activity (no higher than in PBMC of normal rabbits) was maintained for 31 weeks. The ability of PBMC to absorb IL-2, in parallel with its production, was found at the same time in the course of syphilis infection (7-11 weeks). In long-lasting syphilis (more than 12 weeks) both abilities seem to be inhibited. Sera of syphilitic rabbits were found to have a higher level of IL-2 inhibitor than those of normal rabbits. Only in syphilis lasting 9 to 11 weeks, when the production of IL-2 was the greatest, was the level of IL-2 inhibitor nearly the same as in normal rabbit sera. In syphilis lasting longer, the increased level of inhibitor was accompanied by a decreased ability of cells to produce IL-2. These findings suggest that IL-2 inhibitor may be bound to IL-2 or IL-2 receptor on T lymphocytes and in this way would lead to weakening of T cell function and resistance against Treponema pallidum infection.

The suppressive effect of serum samples from patients with chancroid on human mononuclear cells correlates with the clinical picture and is interleukin-2-dependent

Plasma samples from patients with chancroid diagnosed both on clinical and microbiological grounds were assessed for their ability to inhibit mitogen-induced proliferation of human lymphocytes from healthy donors. All serum samples analysed suppressed phytohaemagglutinin A (PHA) blastogenic response. A significant difference in the observed extent was seen when serum samples from patients with and without associated lymphadenopathy were compared (P < 0.05). Using an interleukin-2 (IL-2)-dependent cell line it could be demonstrated that the addition of patients' plasma to cultured cells markedly depressed mitogen-induced IL-2 synthesis. Results presented suggest that cell-mediated mechanisms play a role in the pathogenesis of infection due to Haemophilus ducreyi.

Soluble interleukin-2 receptors in serum and urine of patients with chancroid and their response to therapy

To investigate cell-mediated immune response in chancroid, soluble interleukin-2 receptor levels in serum and urine samples of healthy individuals and patients were measured by an enzyme-linked immunosorbent assay. Increased levels both in serum and in urine were observed in cases of Haemophilus ducreyi infection. In patients showing a prolonged incubation period, urine levels exceeded serum values. Therapy led to a reduction of elevated interleukin-2 receptor levels in serum and in urine.

Detection of a novel "cryptic" plasmid of about 7.8 MDal in a non-penicillinase-producing Neisseria gonorrhoeae isolate from Munich

A novel plasmid of about 7.8 megadaltons (MDal) could be detected in a non-penicillinase-producing Neisseria gonorrhoeae strain isolated in Munich in 1987. As the strain showed no resistance against commonly used chemotherapeutic agents, at present the plasmid must be described as phenotypically "cryptic".

Increase of the relative frequency of penicillinase-producing Neisseria gonorrhoeae strains to more than five per cent in Munich

The relative frequency of penicillinase-producing Neisseria gonorrhoeae strains isolated from Munich STD patients nowadays clearly exceeds five percent. Penicillin resistance is either due to the 3.2 or 4.4 Megadalton plasmid. Similar trends are reported from other European countries. Therefore, treatment with third generation cephalosporins such as ceftriaxone, cefotaxime or others is now generally advisable not only in the Far East and Central Africa but also in Central Europe.

Plasmid content, serotypes, and antimicrobial susceptibility of Neisseria gonorrhoeae strains isolated in Munich in 1987-88

Eighty-four strains of Neisseria gonorrhoeae isolated in Munich between January 1987 and June 1988 were characterized in terms of their plasmid content, protein I serovar and susceptibility or resistance to four antimicrobial agents. Eighty two percent of the strains belonged to serogroup 1B, the three most prevalent serovars being 1B-1, 1B-2 and 1B-6. Among the serogroup 1A strains, 1A-2 was the commonest serovar. Fourteen strains (16.7%) lacked the 2.6 Md cryptic plasmid, although two of these strains contained the conjugative gonococcal plasmid. Although some degree of resistance to penicillin and tetracycline was noted, all the strains were sensitive to spectinomycin and cefotiam.