[Development of an ivermectin-containing syrup as an extemporaneous preparation for treatment of scabies in children]. / Entwicklung eines Ivermectin-haltigen Saftes als Magistralrezeptur für Kinder zur Therapie der Skabies.

BACKGROUND: Oral ivermectin can be used to treat scabies. Evidence for safe and effective use in young children in individual treatment situations has been developed and published. In order to also ensure a body weight-adapted dosage for children, an ivermectin-containing syrup was developed as an extemporaneous preparation. MATERIALS AND METHODS: Since ivermectin is not available as a pure substance for the formulation, tablets containing active ingredient were used as a basic material for development. The formulation was designed according to pharmaceutical, regulatory and use-oriented criteria. An HPLC (high-pressure liquid chromatography) method was developed and validated to demonstrate chemical stability. In order to facilitate the practical implementation, information on suitable packaging material and application aids was also developed and the formulation was evaluated. RESULTS: It has been demonstrated that the final formulation produced in the pharmacy was stable and can be stored for 3 weeks. No concerns were raised regarding the tolerability of the syrup formulation. The physicochemical properties and the taste of the formulation allow the intended use as a well-dosed syrup for children. CONCLUSION: The developed formulation meets the requirements of the Apothekenbetriebsordnung (Pharmacy Work Rules; Section 7 ApBetrO) and enables an exact, body weight-adapted dosage of oral ivermectin in young children. Studies on human pharmacokinetics or clinical studies to demonstrate tolerability and/or efficacy are not available for the formulation.

Isolated recessive nail dysplasia caused by FZD6 mutations: report of three families and review of the literature.

Congenital abnormalities of the nail are rare conditions that are most frequently associated with congenital ectodermal syndromes involving several of the epidermal appendages including the skin, teeth, hair and nails. Isolated recessive nail dysplasia (IRND) is much rarer but has recently been recognized as a condition resulting in 20-nail dystrophy in the absence of other cutaneous or extracutaneous findings. A few case reports have identified mutations in the Frizzled 6 (FZD6) gene in families presenting with abnormal nails consistent with IRND. These reports have highlighted the role of Wnt-FZD signalling in the process of nail formation. We report three families presenting with features of IRND, in whom we identified mutations in FZD6, including one previously unreported mutation.

Association of hormone receptor status with grading, age of onset, and tumor size in BRCA1-associated breast cancer.

BRCA1-associated breast cancer frequently presents with estrogen-receptor (ERalpha) and progesterone-receptor (PR) negativity, grade 3, and early onset. In contrast, in BRCA1-deficient mice, ERalpha is highly expressed in early tumorigenesis. In a retrospective cohort study on 587 breast cancer patients with deleterious BRCA1 mutations, the correlation of ER, PR status, grading, age of onset, and tumor size was investigated. ERalpha and PR expression decreased from 62% in ductal carcinoma in situ (DCIS) to 20% and 16% in pT3, respectively (p value for ER 0.025 and PR 0.035, Fisher's exact test). The percentage of grade 1/2 tumors decreased from 44% in DCIS to 17% in pT3 (p value 0.074). Moreover, ER/PR positivity increased with increasing age. Our data suggest that early stage BRCA1-associated breast cancers are more frequently ERalpha and PR positive and low grade than advanced stages.

Neonatal alcohol exposure augments voluntary ethanol intake in the absence of potentiated anxiety-like behavior induced by chronic intermittent ethanol vapor exposure.

Individuals fetally exposed to alcohol have a disproportionate risk for developing lifetime alcohol dependence, an association that may be confounded by the presence of comorbid conditions, such as anxiety. Anxiety is also observed following fetal alcohol exposure and is known to exacerbate ethanol consumption, highlighting the utility of animal models to assess this relationship. The present study evaluated the impact of third-trimester equivalent ethanol exposure on ethanol consumption and anxiety-like, marble burying behavior in adult, male C57BL/6 mice following exposure to chronic intermittent ethanol vapor, proposed to model dependence. Neonatal mice (P5-6, 2.5-3.0 g) were administered one injection of saline or ethanol (2.5 g/kg, subcutaneously [s.c.]). Pre-vapor marble burying and limited-access two-bottle choice ethanol intake (15% v/v, 2 h) were comparable in adults (8 weeks of age) across neonatal treatment groups. Five consecutive drinking sessions were repeated 72 h after each weekly ethanol vapor exposure procedure for a total of five vapor/drinking cycles. Consistent with prior research, an increase in voluntary ethanol drinking was observed in vapor-exposed, neonatal saline-treated mice throughout the study starting after the second vapor cycle compared to both air-exposed control groups. In neonatal ethanol-treated mice, this increase in ethanol intake and preference following vapor exposure was accelerated, being observed after the first vapor cycle, and observed at an augmented level compared to vapor-exposed, neonatal saline-treated mice and air controls for both neonatal conditions. Conversely, marble burying was enhanced equivalently in vapor-exposed mice from either neonatal treatment group relative to their respective air-exposed controls. These data recapitulate clinical observations of enhanced sensitivity for alcohol dependence following developmental alcohol exposure, which may reflect enhanced motivational drive rather than potentiated negative affect. The present model will facilitate the future exploration of mechanisms that underlie increased risk for alcohol use after early developmental exposure.

[Skincycle of a new spontaneous mutant (Nackig) with abnormal hair keratinization in the mouse (author's transl)]. / Uber den Hautcyclus einer neuen Spontanmutante (Nackig) mit mangelhafter Haarkeratinisierung bei der AMus.

The pathomorphological and pathophysiological reactions of the first skincycle of the mutant (Ng) were histologically investigated. 1. During the hair growth disturbances as the result of imperfect keratinisation changes of the morphology and function of different skin areas could be observed. 2. The developments of abnormal thinner hair growth were correlated to hyperorthokeratotic, inter-respectively intrafollicular hyperplasia of the epidermis and to infraseboglandular hypoplasia of the follicles. 3. The hyper- and hypoplasia of the epidermis corresponded with a functional pseudohypo- and pseudohypertrophy of the cutis. 4. During the skincycle the perifollicular epithelium ranged from the inter- to intrafollicular skin areas. The inter- and intrafollicular epidermal sections varied simultaneously. 5. These results are important for the understanding of some pathomorphological and pathophysiological reactions of skin compartments of man.

[Oxygen consumption of the spontaneous and artificially induced skincycle at different times of day (author's transl)]. / Der Sauerstoffverbrauch des spontanen und künstlich induzierten Hautcyclus zu verschiedenen Tageszeiten.

In the "clean" rat skin purified from the panniculus carnosus the oxygen consumption of the spontaneous and artificially induced skincycle was measured at different times of day. The level of oxygen consumption correlated to diurnal and nocturnal periods. During the skincycle the oxygen consumption showed fluctuations. There were indications that the value of oxygen consumption of the early anagen is influenced by that phase of the cycle at which the new cycle is artificially induced. Furthermore, it was found that a certain decrease of oxygen consumption stimulates the quiescent hair follicles to spontaneous proliferation. During the katagen the peak value of the oxygen consumption seemed to be correlated with specially morphofunctional perifollicular changes. The application of these findings to the pathophysiology of human hair growth disturbances is discussed.

23-Year-Old Female with an Inflammatory Myofibroblastic Tumour of the Breast: A Case Report and a Review of the Literature.

Purpose: Inflammatory myofibroblastic tumours (IMT) are a subcategory of inflammatory pseudotumours (IPT). They arise most commonly in the abdominopelvic region, lung and retroperitoneum, but virtually any anatomical site may be involved. Predominantly children and adolescents are affected and there is a tendency for local recurrence. In the literature up to the present, 20 patients have been reported with an IPT/IMT of the breast. We would like to present another patient with this unusual tumour entity of the breast and discuss the literature. Patient and Examinations: A 23-year-old woman presented with a painless lump in her left breast. There was no history of breast cancer in her family. Sonography showed a hypoechoic heterogeneous solid mass with irregular margins. A core needle biopsy revealed a tumour of high cellularity and a densely collagenous background. Immunohistochemically, the spindle-shaped cells were immunoreactive to smooth muscle actin and ALK-1 protein. Additional FISH analysis proved ALK rearrangements on chromosome 2p23 leading to the diagnosis of an IMT. Wide surgical excision was performed with no evidence of local recurrence after 12 months. Conclusion: Three of the above mentioned 20 patients with IMT/IPT of the breast developed a recurrent tumour, none presented with distant metastasis. A significant recurrence rate of 15 % leads to a clinically and sonographically close follow-up in these patients.

Platinum sensitivity in a BRCA1 mutation carrier with advanced breast cancer.

Although BRCA1-associated breast carcinomas are frequently detected in nodal-negative stage, they typically present with an aggressive histopathological phenotype that is reflected by a poor prognosis and an increased risk for distant metastatic spread. Recent in vitro data suggest a high sensitivity of BRCA1-associated carcinomas to platinum-based chemotherapy and a lower sensitivity to anthracyclines and taxanes. This is explained by the key role of BRCA1 in DNA double-strand repair via homologous recombination, thereby leading to a higher sensitivity to DNA intercalating agents, such as platinum. Here we present the case of a woman suffering from BRCA1-associated metastatic breast carcinoma that was resistant to docetaxel, but responded strongly to cisplatin-containing chemotherapy. This supports the rationale of ongoing clinical studies.

DNA microarray analysis identifies candidate regions and genes in unexplained mental retardation.

OBJECTIVE: Because in most patients with mental retardation (MR), who constitute 2 to 3% of the population, the etiology remains unknown, we wanted to identify novel chromosomal candidate regions and genes associated with the MR phenotype. METHODS: We screened for microimbalances in 60 clinically well-characterized patients with unexplained MR mostly combined with congenital anomalies. Genome-wide array-based comparative genomic hybridization was performed on DNA microarrays with an average resolution of <0.5 Mb. We verified every nonpolymorphic array clone outside the diagnostic thresholds by fluorescence in situ hybridization and performed breakpoint analyses on confirmed imbalances. RESULTS: Six presumably causal microimbalances were detected, five of which have not been reported. Microdeletions were found in five patients with MR and distinctive facial features, who also had neurologic findings (three cases), brain anomalies (two cases), and growth retardation (two cases), in chromosomal bands 6q11.1-q13 (10.8 Mb), Xq21.31-q21.33 (4.0 Mb), 1q24.1-q24.2 (3.8 Mb), 19p13.12 (2.1 Mb), and 4p12-p13 (1.1 Mb). One microduplication was detected in 22q11.2 (2.8 Mb) including the DiGeorge syndrome critical region in a patient with mild MR, microcephaly at birth, and dysmorphisms. Three imbalances were shown to be de novo and two inherited. The Xq21 microdeletion in a boy with borderline intellectual functioning was inherited from a normal mother; the 22q11.2 microduplication was inherited from a normal father and was present in two affected siblings. CONCLUSION: We could identify novel microimbalances as the probable cause of mental retardation in 10% of patients with unclear etiology. The gene content of the microimbalances was found to correlate with phenotype severity. Precise breakpoint analyses allowed the identification of deleted genes presumably causing mental retardation.

Design of high affinity cyclic pentapeptide ligands for kappa-opioid receptors.

Using results from our previously reported cyclic opioid peptide series and reliable models for mu-, delta-, and kappa-opioid receptors (MOR, DOR, and KOR, respectively) and their complexes with peptide ligands, we have designed and synthesized a series of cyclic pentapeptides of structure Tyr-C[D-Cys-Phe-Phe-X]-NH2, cyclized via disulfide, methylene, or ethylene dithioethers, and where X = D- or L-Cys; or D- or L-penicillamine (Pen; beta,beta-dimethylcysteine). Determination of binding affinities to MOR, DOR, and KOR revealed that members of this series with X = D- or L-Cys display KOR affinities in the low nanomolar range, demonstrating that a 'DPDPE-like' tetrapeptide scaffold is suitable not only for DOR and MOR ligands, but also for KOR ligands. The cyclic pentapeptides reported here are not, however, selective for KOR, rather they display significant selectivity and high affinity for MOR. Indeed, peptide 8, Tyr-C[D-Cys-Phe-Phe-Cys]-NH2-cyclized via a methylene dithioether, shows picomolar binding affinity for MOR ( = 16 pm) with more than 100-fold selectivity for MOR vs. DOR or KOR, and may be of interest as a high affinity, high selectivity MOR ligand. Nonetheless, the high affinity KOR peptides in this series represent excellent leads for the development of structurally related, selective KOR ligands designed to exploit structurally specific features of KOR, MOR, and DOR.

Roles of residues 3 and 4 in cyclic tetrapeptide ligand recognition by the kappa-opioid receptor.

A series of cyclic, disulfide- or dithioether-containing tetrapeptides based on previously reported potent mu- and delta-selective analogs has been explored with the aim of improving their poor affinity to the kappa-opioid receptor. Specifically targeted were modifications of tetrapeptide residues 3 and 4, as they presumably interact with residues from transmembrane helices 6 and 7 and extracellular loop 3 that differ among the three receptors. Accordingly, tetrapeptides were synthesized with Phe(3) replaced by aliphatic (Gly, Ala, Aib, Cha), basic (Lys, Arg, homo-Arg), or aromatic sides chains (Trp, Tyr, p-NH(2)Phe), and with d-Pen(4) replaced by d-Cys(4), and binding affinities to stably expressed mu-, delta-, and kappa-receptors were determined. In general, the resulting analogs failed to exhibit appreciable affinity for the kappa-receptor, with the exception of the tetrapeptide Tyr-c[d-Cys-Phe-d-Cys]-NH(2), cyclized via a disulfide bond, which demonstrated high binding affinity toward all opioid receptors (Ki(mu) = 1.26 nm, Ki(delta) = 16.1 nm, Ki(kappa) = 38.7 nm). Modeling of the kappa-receptor/ligand complex in the active state reveals that the receptor-binding pocket for residues 3 and 4 of the tetrapeptide ligands is smaller than that in the mu-receptor and requires, for optimal fit, that the tripeptide cycle of the ligand assume a higher energy conformation. The magnitude of this energy penalty depends on the nature of the fourth residue of the peptide (d-Pen or d-Cys) and correlates well with the observed kappa-receptor binding affinity.

[Psychosomatic criteria in the treatment of atopic neurodermatitis]. / Psychosomatische Kriterien bei der Behandlung der Neurodermitis atopica.

We report on psychosomatic aspects regarding out-patient and hospital treatment of atopic dermatitis, including information concerning the disease, motivation for psychotherapeutic forms of treatment (relaxation, diagnostic and therapeutic conversation), as well as psychosomatic indicators for the discharge from hospital.

[Contraceptive agents and growth of hair on the model of pregnancy from the animal experiment viewpoint]. / Kontrazeptiva und Haarwachstum unter tierexperimentellen Aspekten am Modell der Trächtigkeit.

PIP: The effects of contraceptives on hair growth were studied with pregnant mice and guinea pigs as models. Laboratory experiments revealed that during pregnancy (in mice and guinea pigs) there is an inhibition of the induction of hair growth, e.g., telegonization. Postpartum this inhibition ceases and hair growth is accelerated. This process can be induced through administration of estrogen substances, and, to a lesser extent, with androgen substances. A demonstrated dependency of new hair growth at the end of lactation suggests another causative factor (protein metabolism) which may not be significant for conditions related to contraceptive medication. These experiments suggest that probably estrogen effects on hair growth will accompany contraceptive therapy. The endocrinological constitution of the individual user and the composition of the drugs will determine the extent of the hormonal effect on hair growth. Under favorable conditions an existing hair loss may be corrected, when instead of an inhibiting summation effect (androgenetic alopecia plus gestagen with androgenetic effect), an endocrinological balance takes place in a physiological sense. These findings can be applied to human beings only with great caution.^ieng

[Effect of pregnancy and lactation on hair growth in mice (author's transl)]. / Einfluss von Gravidität und Lactation auf den Haarwuchs der Maus

The influence of pregnancy and suckling in mice on spontaneous, induced hair growth and on body weight was examined. 1. An inhibition of spontaneous and induced growth of hair some days before delivery was found. 2. The initiation of hair growth was found not to be wave-like as usually, but nearly simulatneously. 3. Inhibition and initiation of hair growth seem to be related to body weight. 4. The influences on hair growth in mice are compared with known effects of pregnancy on hair growth in women.

[Dysmorphophobia as casus pro diagnosi]. / Dysmorphophobie als casus pro diagnosi.

Our psychodiagnostic studies were concerned with two female patients considering themselves disfigured although their residual somatic findings were only minimal. Two main factors could be derived from analysis: "feelings of anxiety and insecurity" and "obsessive-compulsiveness". The compulsive and sometimes paranoid ideas of the patients suffering from dysmorphophobia require differentiated conclusions by the doctor.

[The pruritus of endogenous eczema patients (author's transl)]. / Der Juckreiz des endogenen Ekzematikers.

The psychosomatic aspects of the pruritus symptom of endogenous eczema patients are presented. The phenomenon of "scratching" is analysed descriptively from observations of the behavior of the patient and his family. Psychotherapeutic approaches as a supplement to the dermatological therapy of endogenous eczema are described.

[Confronting the artefact patient with manipulative behavior]. / Zur Frage der Konfrontation des Artefaktpatienten mit seinem manipulativen Verhalten.

Patients with self-inflicted skin disorders form a rather heterogeneous group. Our paper is intended to provide the practitioner with some orientation concerning interaction and therapeutic procedure in patients with artefactual skin diseases. Basically, these patients should be differentiated according to what extent they are aware of their manipulations. This degree of awareness should then be the guideline for a well-dosed and sensitive confrontation with their manipulative behavior. In any case, a positive result of the confrontation largely depends on the confidential relationship between physician and patient.