[Deployment of a dermatologist in Cambodia and Somalia: Personal experience of a medical officer]. / Als Einsatzdermatologe in Kambodscha und Somalia: Ein persönlicher Erfahrungsbericht.

BACKGROUND: Throughout history, physicians of the armed forces have gained experience in tropical medicine during deployment in tropical countries. PATIENTS AND METHODS: During deployments in Cambodia and Somalia, dermatologists treated participants of the UN missions and also local people to win their confidence. The experience acquired during these missions is reported. RESULTS: The dermatologist was mainly confronted with the diagnosis and treatment of infectious skin diseases, including genitourinary diseases. Therapy of parasitic infections rarely imported to Europe was a challenge. CONCLUSION: Training and experience in Tropical Medicine are essential for medical officers deployed on missions as well as for physicians advising travellers.

[Blister beetle dermatitis: Dermatitis linearis]. / Blasenkäfer-Dermatitis: Dermatitis linearis.

Several families of beetles cause toxic reactions on exposed human skin. Cantharidin provokes nearly asymptomatic vesicles and blisters, while pederin leads to itching and burning erythema with vesicles and small pustules, later crusts. Paederi are attracted by fluorescent light especially after rain showers and cause outbreaks in regions with moderate climate. Clinical findings and patient history lead to the diagnosis: dermatitis linearis.

[Epidemiology and prevention of leishmaniasis in northern Afghanistan]. / Epidemiologie und Prophylaxe der Leishmaniasis in Nordafghanistan.

BACKGROUND: Leishmaniasis is estimated to cause the ninth largest disease burden among infectious diseases worldwide and it is not preventable by vaccination or chemoprophylaxis, but only by personal protective measures preventing bites of infectious arthropod vectors. OBJECTIVES: Which leishmania species are endemic in northern Afghanistan, what are the clinical characteristics of skin lesions produced by cutanizing leishmania species, what are their epidemiological characteristics, and which preventive measures are feasible? METHODS: The medical literature was reviewed, knowledge gaps were analyzed and completed by our own data collected locally. RESULTS: Four Leishmania species are considered endemic in northern Afghanistan, of which Leishmania tropica, L. major, and L. donovani can produce skin lesions while L. donovani and L. infantum visceralize. Transmission modes and seasons vary markedly among focally epidemic urban anthroponotic L. tropica and rural enzootic L. major. Combined preventive measures may reduce the infection rate by more than 10,000-fold. CONCLUSION: Cutaneous as well as visceral leishmaniasis can occur among returnees from Afghanistan. Atypical, poorly healing skin lesions can be caused by L. donovani. Extensive use of personal protective measures against arthropod vectors is strongly recommended for all travelers.

[Cutaneous leishmaniasis. Diagnosis and therapy in northern Afghanistan]. / Erfahrungen mit der kutanen Leishmaniasis. Diagnostik und Therapie im Einsatz in Nordafghanistan.

BACKGROUND: The German S1 guidelines from 2009 contain a variety of recommendations for the treatment of cutaneous leishmaniasis. PATIENTS AND METHODS: We report the results of our diagnostic procedures and treatment of 32 international patients in autumn 2010 in northern Afghanistan. RESULTS: Giemsa stain confirmed the clinical diagnosis within 24 hours. Eleven simple lesions and one larger ulcer responded well to cryotherapy and intralesional sodium stibogluconate. More complex lesions in 19 patients responded well to oral miltefosine. One patient refused outpatient therapy. CONCLUSIONS: Cryotherapy and intralesional antimony compounds showed good results in early lesions of cutaneous leishmaniasis in northern Afghanistan. Outpatient treatment of complex lesions with miltefosine was successful in all cases.

Development and characterization of a monoclonal antibody which distinguishes the beta-subunit of human chorionic gonadotropin (beta hCG) in the presence of the hCG.

A monoclonal antibody specific for the beta-subunit of human chorionic gonadotropin (beta hCG) has been developed which has a cross reactivity of 0.23% with intact hCT. There was no cross reactivity with other glycoprotein pituitary hormones in the range in which they might be expected to be present in serum. The beta-subunits of hFSH, hTSH and hLH did not inhibit binding of [125I]iodo-beta hCG to the antibody at up to 250 ng/tube. The dissociation constant (Kd) with [125I]iodo-beta hCG was 3.3 x 10(-10), and the reaction had reached equilibrium within 1 h.

Correlation of histopathologic evidence of disease activity with the presence of immunoglobulin-containing cells in the colons of patients with inflammatory bowel disease.

Immunofluorescence of formalin-fixed, paraffin-embedded tissues was performed to study the plasma cell population in 114 colonic specimens from 58 patients. Correlation of the histopathologic stage of disease activity with the isotypes and numbers of immunoglobulin-containing cells in the lamina propria demonstrated highly significant (P less than 0.001) increases in the mean numbers of IgG- (18-fold), IgA- (twofold) and IgM- (sixfold) containing cells in specimens from patients with active inflammatory bowel disease as compared with control specimens. Increased numbers of immunoglobulin-containing cells were uncommon in inactive inflammatory bowel disease and in reactive mucosa. No deposition of immunoglobulin-containing immune complexes was found at any stage of disease activity. These findings suggest that immune complex-mediated damage does not play a major role in the epithelial damage in inflammatory bowel disease. In future studies, it will be of importance to determine whether the antibody from immunoglobulin-containing cells seen in patients with inflammatory bowel disease can effect damage via an antibody-dependent cell-mediated cytotoxicity mechanism.

[Therapy of hydrofluoric acid burns]. / Zur Therapie der Flusssäureverätzung.

Burns caused by exposure to hydrofluoric acid require immediate First Aid and specific therapeutic measures by the first available physician. Based on a review of the literature the following outline of therapy is proposed.

Receptor for bacteriophage lambda of Escherichia coli forms larger pores in black lipid membranes than the matrix protein (porin).

The receptor for phage lambda in Escherichia coli was isolated by cholate extraction and purified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Protein bands corresponding to the monomer and the dimer were eluted from the gel and tested for their activity to inactivate phage lambda and to form pores in black lipid membranes. It was found that only the dimer inactivated phage lambda, whereas both the monomer and the dimer were active in forming pores. The pore characteristics were similar to those exhibited by the matrix protein (porin) (R. Benz, K. Janko, W. Boos, and P. Läuger, Biochim. Biophys. Acta 511:305--319, 1978). In comparison, the lambda receptor showed a somewhat higher degree of cation specificity, and its pore size was larger. Assuming that the thickness of the outer membrane is 7.5 nm and that the pore is an ideal hydrophilic channel, the pore diameter in vivo was estimated to be 1.6 nm for the lambda receptor and 1.2 nm for the matrix protein.

Porin activity in the osmotic shock fluid of Escherichia coli.

Osmotic shock fluid of Escherichia coli exhibited pore-forming activity. This activity could be followed by an in vitro assay based on the conductivity increase for ions due to the presence of pores in black lipid membranes. The histogram (the distribution of conductivity increments in a single pore experiment) obtained with osmotic shock fluid from E. coli was identical to the histogram obtained by detergent-solubilized porin isolated from the outer membrane. The osmotic shock fluid from porin-negative mutants also exhibited pore activity, although the histogram and ion specificity were different from those of porin. Antibodies raised against detergent-solubilized porin were able to form precipitin lines by the Ouchterlony immunodiffusion technique when shock fluids, but not detergent-solubilized porin, were used. These antibodies prevented the formation of pores when shock fluids contained porin but not when shock fluids obtained from porin-negative mutants were used. Macroscopic membrane conductivity of shock fluids due to porin exhibited a concentration dependence, in contrast to detergent-solubilized porin. These results indicate that the hydrodynamic properties of periplasmic or "soluble" porin are different from those of the detergent-solubilized porin of the outer membrane. Periplasmic porin comprises about 0.7% of total protein in the osmotic shock fluid.

Factors affecting enzyme-linked immunosorbent assay (ELISA) for insulin antibodies in serum.

We have evaluated the factors affecting an enzyme-linked immunosorbent assay (ELISA) for circulating insulin antibodies. Dilutions of patients' sera were incubated in polystyrene tubes coated with procine insulin. The second incubation was with alkaline phosphatase-conjugated anti-human Fab. Each of these reactions was complete after 4 h. Specificity of the reaction for insulin antibodies was demonstrated by removal of anti-insulin activity after preincubation with insulin, but not with glucagon at similar concentrations. Sensitivity of the ELISA system, assessed by performing the reaction with affinity-column purified insulin antibodies, was 10 microgram of specific antibody per liter. Using this system, we examined sera from 22 patients who had been determined by radioimmunoassay to have insulin antibodies, and sera from 23 normal individuals. The ELISA results correlated reasonably well with those of RIA (r = +0.84). Besides detecting insulin antibodies in diabetic patients who are being treated with insulin, we use this ELISA test as a screening procedure to be certain insulin antibodies are not present when we use indirect immunofluorescence methods of fixed pancreatic substrate to detect islet-cell antibodies.

[Hypothermic circulatory arrest after total blood exchange in dogs (author's transl)]. / Hypothermer Kreislaufstillstand nach totalem Blutaustausch beim Hund.

Total body washout (hct less than 1%) in hypothermia was performed in 31 dogs using either a crystalloidal or a colloidal perfusate. Blood exchange and cooling was achieved by means of partial bypass and heat exchanger. Short lasting blood exchange for crystalloids without cardiac arrest resulted in 66% survival of the animals. When in addition circulatory arrest was established for 30 min at 14 degrees C oesophageal temperature blood exchange for crystalloids was not tolerated. All four animals of this group died within 19 hours presenting massive interstitial edema. Replacement of the crystalloidal perfusate by a colloidal solution (2.5 g% Dextran 60 at Ringer's Lactate) and establishing circulatory for 30 or 60 min resulted in survival rates of 71% and 50% respectively. The use of the colloidal perfusate effectively prevented edema formation. Death could not be correlated with the parameters controlled.