[Successful treatment of panarteritis nodosa with low-dose methotrexate therapy]

We report on a 45-year-old male patient who presented a classic polyarteritis nodosa (PAN). The clinical course extended over 7 years. In spite of 2 years immunosuppressive therapy with azathioprine and methylprednisolone the course was progressive. Low-dose methotrexate therapy was the only treatment that controlled the disease, leading to rapid clinical and histopathological remission. In low concentrations methotrexate acts as an IL-1 inhibitor, and it obviously suppresses the pathogenetic mechanism of PAN.

[Chondroid syringoma. Immunohistologic indications of myoepithelial differentiation]

Chondroid syringoma belongs to the group of so-called mixed tumors, like pleomorphic adenomas of the lacrimal and salivary glands. The histogenesis of this tumour is still disputed, in particular with respect to its stromal component. The distribution of cytokeratins (CKs), CEA, EMA, vimentin, S-100 protein, desmin and actin [alpha-smooth muscle actin (alpha-SMA)] was investigated by immunohistological examination of paraffin sections from a chondroid syringoma of the apocrine type. The neoplastic formations have been classified into tubuloalveolar structures, solid nests/aggregations and stromal cells of varying morphology. The inner-most cells of tubuloalveolar structures were characterized by marked expression of CKs (KL1 and MNF116), CEA and EMA, while in the outer ones there was moderate expression of vimentin, S-100 was expressed to a lesser extent and KL1, weakly but there was marked and consistent expression of MNF116. Whereas the solid nests expressed vimentin, S-100 protein, MNF116 markedly and KL1 weakly, the stromal cells were consistently positive for vimentin, S-100 protein and, focally, CKs and alpha-SMA. Anti-alpha-SMA specifically detects myoepithelial cells. In addition, the partly overlapping immunoreactivity of the intermediate filaments, membrane proteins and proteins in the different structures may indicate a common clonal origin of all neoplastic cells in chondroid syringoma.

[Chronic bullous dermatosis in childhood (linear IgA dermatosis)]

A 5-year-old boy presented with disseminated, partly grouped blisters indicative of chronic bullous dermatosis of childhood (CBDC) following a gastrointestinal infection 2 weeks earlier. CBDC has long been differentiated from adult linear IgA disease. Clinical and laboratory studies revealed substantial clinical and immunological overlap between the two blistering disorders, whereas recent investigations suggest heterogeneity of the target antigen involved. Pathohistological and immunofluorescence-microscopical characteristics of a subepidermal blister and linear IgA and granular C3 deposition at the basement membrane together with the typical history and clinical signs were decisive in the differential diagnosis. The disease promptly cleared up after daily administration of 16 mg methylprednisolone-21-acetate tapering and 25 mg dapsone. Immunohistological detection of collagen IV at the base of a blister made it possible to localize the split above the lamina densa. The demonstration of collagen IV stresses the importance of immunodermatopathology in the differential diagnosis of subepidermal blistering diseases.

[Acrosyringium and follicular infundibulum: immunomorphologic aspects]

Acrosyringium and infundibulum are epidermal structures with different morphology, but functional similarities regarding re-epithelialization, transport of antigens, and attraction of infiltrates. Immunomorphologically, the infundibula revealed an immunoreactivity of Langerhans cells and keratinocytes comparable with that of the interfollicular epidermis, whereas the acrosyringia reacted differently because of the permanent expression of MHC class II antigens and reduced Langerhans cells in the perisyringial region. Our findings suggest that these epidermal compartments differ with regard to their individual immunologic situations. While the mechanisms of epidermal immunity known from the interfollicular epidermis are possibly the same in the infundibula, we have to expect a basically different immunologic situation in the acrosyringia.

Role of hyperperfusion in different glomerular diseases

In various forms of glomerulonephritis, diabetic glomerulosclerosis and decompensated benign nephrosclerosis hyperperfusion injury of the glomeruli may be found in addition to the basic disease in patients with malignant hypertension. The changes consist of adhesions, subendothelial capillary hyalinosis and fat droplets in the hyalin material and in endothelial cells. They occur far more often in males than in females. The highest frequency of hyperperfusion injury was found in patients with membranoproliferative glomerulonephritis type I. The lowest frequency was found with membranous glomerulonephritis. The juxtamedullary part of the kidney, which is not autoregulated, is earlier and more severely affected than the subcapsular part. Hyperperfusion changes occur in the middle and eventually in the subcapsular part of the cortex only when the glomeruli in the juxtamedullar cortex are sclerotic.

Hyperperfusion injury of the human kidney in different glomerular diseases

Investigations of biopsy material from human kidneys with different forms of glomerulonephritis (n = 1,240) and with diabetic glomerulosclerosis (n = 406) performed in order to find changes caused by hyperperfusion of the kidney tissue gave the following results: (1) Hyperperfusion injury occurs in the different forms of glomerulonephritis with varying frequency. It was rarely found in immunologically negative mesangioproliferative glomerulonephritis. The highest incidence was found in patients with membranoproliferative glomerulonephritis type I. (2) Hyperperfusion injury was also found in kidneys with diabetic glomerulosclerosis. The frequency of this finding increased with the degree of the diabetic changes. (3) The hyperperfusion injury was seen as a complication of glomerulonephritis or diabetic glomerulosclerosis only when the patient clinically had developed malignant hypertension and when the serum creatinine level was elevated, a sign of compensated retention. (4) In patients with glomerulonephritis, the hyperperfusion changes occurred more frequently in males than in females. Diabetic glomerulosclerosis was complicated by hyperperfusion injury with the same frequency in both sexes. (5) Patients with hyperperfusion changes of the kidneys always excrete large amounts of protein in the urine. (6) Hyperperfusion changes occur first in the juxtamedullary glomeruli. The intermediate glomeruli are affected later and the subcapsular glomeruli last.

[Effect of local moderate hyperthermia in combination with chemotherapy by N-nitroso-1,3-bis-(2-chloroethyl)urea (BCNU) on the descending colon of the rat with transplanted Yoshida sarcoma. 2. Monochemotherapy in combination with subsequent hyperthermia at various time intervals]

There are numerous reports on in vitro and in vivo investigations of hyperthermia for cytostasis of malignant tumors. Combination of chemotherapy and hyperthermia is to potentiate the therapeutic effect. The time interval between the two types of therapy was the main subject of the present investigation. Local hyperthermia (43 degrees C, 60 min) following BCNU chemotherapy at intervals of 0, 3, 6, 9, 12, and 24 h, respectively, was studied in a colonic Yoshida sarcoma model in Sprague-Dawley rats. No significant increase in the curing rate resulted from hyperthermic treatment. The results suggest that the highly anticipated hyperthermic peritoneal lavages should be investigated in controlled animal experiments prior to clinical use.

[Effect of local moderate hyperthermia in combination with N-nitroso-1,3-bis-(2-chloroethyl)urea (BCNU) and 5-fluoro-(tetrahydro-2-furyl)uracil (ftorafur) on induced autochthonous colonic cancers in the rat. 3: Polychemotherapy in combination with hyperthermia]

The use of hyperthermia for the treatment of tumors has been tested in vitro and in vivo experiments as well as clinically for a long time. Combination of hyperthermia with chemotherapy was reported to result in overadditive cytostatic effects. In a clinically adapted, controlled animal experiment, local moderate hyperthermia (43.5 degrees C, 3 X 60 min) alone and in combination with polychemotherapy (BCNU) and Ftorafur) was used for the treatment of AMMN-(N-nitrosoacetoxymethyl-methylamine) induced autochthonous colonic carcinomas in Sprague-Dawley rats. Diagnosis and follow-up inspections were carried out endoscopically. The applied therapies did not result in prolonged survival times, nor was an additive effect seen after combined hyperthermia and chemotherapy in this "hard", i.e. relatively chemotherapy-resistent, tumor model.