Diagnostic value of PCR for detection of Borrelia burgdorferi DNA in clinical specimens from patients with erythema migrans and Lyme neuroborreliosis.

BACKGROUND: The aim of the study is to evaluate the diagnostic sensitivity of a 16S ribosomal RNA-based PCR on clinical specimens from patients with erythema migrans (EM) and neuroborreliosis and to compare the sensitivities with those obtained by in vitro culture and serological testing. A semiquantitative detection system, representing the input amount of specific DNA and thus the density of spirochetes in clinical specimens, indicated the preferred clinical sample to obtain for PCR testing. METHODS AND RESULTS: Skin biopsy and urine samples from 31 patients with EM and cerebrospinal fluid (CSF) and urine samples from 30 patients with neuroborreliosis were investigated. Borrelia burgdorferi DNA was detected in 71% of the skin biopsy specimens and 13% of the urine samples from patients with EM. Forty-one percent of the patients with EM were found to have B burgdorferi-specific antibodies in serum, and B burgdorferi was cultured in 29% of the EM specimens. For patients with neuroborreliosis, the diagnostic sensitivities in CSF and urine samples were 17% and 7%, respectively. Specific intrathecal antibody production was found in 90% of the patients, and 87% showed elevated B burgdorferi antibodies in serum. In general, PCR of skin biopsy samples yielded very high amounts of amplicons versus low amounts for CSF and urine samples. CONCLUSIONS: PCR of skin biopsy specimens is currently the most sensitive and specific test for the diagnosis of patients with EM, superior to culture and serological testing. For B burgdorferi-specific CSF disgnosis in patients with neuroborreliosis, the measurement of specific intrathecal antibody synthesis is superior to PCR. However, in patients with a short duration of disease (<14 days), PCR may be a useful diagnostic supplement. PCR of urine samples cannot be recommended at the present time for routine diagnosis of patients with EM or neuroborreliosis.

Herpes gestationis in association with neoplasma malignum generalisata. A case report.

A case of herpes gestationis (HG) and a hormone producing tumour in a woman is presented. The disease had a fulminant course and the patient deceased within months. Fifteen years ago a hydatidiform mole had been removed. Only rarely has HG been associated with hydatidiform mole and choriocarcinoma. We believe that our patient had a human chorionic gonadotrophin (HCG) producing germ cell tumour. Although extremely seldom encountered, the association of HG to neoplasms should be kept in mind.

Angiosarcoma of the leg. A case report.

A patient with angiosarcoma on the lower leg is presented. The lesion resembled primarily an atypical varicose ulcer, but was immediately suspected of malignancy. Four biopsies could not confirm our suspicion. Only after total excision of the area the diagnosis angiosarcoma was established. This indicates that deep biopsies should be taken from all parts of a tumour suspected of this type of malignant disease.

Cholesteatoma: a morphologic study of stratum corneum lipids.

Two different lipid-retaining fixation techniques permitted electron microscopic visualization of both intra- and extracellular lipids in cholesteatoma epithelium obtained from 25 patients. An increased number of intracellular lipid-containing Odland bodies was demonstrated, with a maximum in the basal layer of the stratum granulosum, while the superior layer contained substantially fewer organelles than are found in normal skin. At the stratum granulosum/stratum corneum interface lipids secreted from Odland bodies were found in sac-like invaginations along the cell membrane but premature exocytosis was also frequently observed. In the intercellular spaces of the stratum corneum, multiple long sheets of lamellar structures interrupted by slits or pores enclosed the keratinized corneocytes. The intercellular spaces seemed narrow and an extracellular barrier was not found until well above the stratum granulosum/stratum corneum interface. A similar distribution of Odland bodies and structure of intercellular lipids can occur in several dermatoses, where the formation and maintenance of the cutaneous permeability barrier are defective.

[Bone changes following long-term isotretinoin (Roaccutane) treatment]. / Knogleforandringer ved langtids isotretinoin (Roaccutan) behandling.

The case is presented of a 33-year-old man treated with Roaccutane for two years on account of severe acne conglobata. X-ray examination after two years showed pronounced hyperostoses with bridging in the thoracic spine and hyperostoses and beginning bridging in the cervical spine. Furthermore, small exostoses were found on the hands and feet. X-ray control of patients treated for more than six months with Roaccutane is recommended.

[Occupational systemic sclerosis in men]. / Arbejdsbetinget systemisk sklerodermi hos maend.

An analysis of the history of 28 men suffering from systemic sclerosis, diagnosed at our department during the last 25 years, showed that 21 (75%) had been subject to exposures previously suggested to be of importance in occupational scleroderma. The exposures were revealed by patient files, reports to health authorities, interviews and/or answers to questionnaires. Organic solvents being the most frequent exposure. This was found in thirteen of the patients (46%). A significant difference was found between scleroderma patients and control patients not suffering from connective tissue diseases in relation to total number of subjects exposed to one or several of the agents in question.

Occupational skin diseases: reliability and utility of the data in the various registers; the course from notification to compensation and the costs. A case study from Denmark.

Occupational diseases affect many people and may have serious social and economic consequences. In 1984, the National Labour Inspection Service established the Register of Occupational Diseases (ROD). The purpose of the central register was to provide information about injury-causing factors and risk groups, etc., changes in risk factors (ongoing monitoring and warning system), and to document the effects of preventive activities. However, we are dealing with several uncertain factors (i.e., whether the number of notified cases is too high or too low), and although the ROD contains a lot of information, it basically represents only notified (suspected) cases, until otherwise proven. Therefore, the utility and reliability of the data in the ROD may be questionable. The National Board of Industrial Injuries and the insurance companies represent recognized and compensated (genuine) cases, but their registers in general contain little information on variables. Thus, it is difficult to obtain exact information of occupational diseases (i.e., the real frequency and causes). What is known, is the number of cases that are notified, recognized and compensated, and the costs. Clearly, the higher the frequency of recognition, the more representative the data in the ROD of the recognized (genuine) cases. Therefore, the course from notification to recognition, and from recognition to compensation was calculated, and, for each step, the importance of skin diseases was considered. Only in the case of skin diseases, was the frequency of recognition high (2/3), and the data in the ROD were considered in more detail, and, where possible, compared with recognized and compensated cases. The various registers concurrently showed that nearly all occupational skin diseases were eczematous in nature (98%), most cases belonged to the younger age group (2/3), women (2/3) predominated over men, and the dominant type of occupational eczema was irritant (2/3). It has not been possible to get further information about exposure sources, occupations and trades from the other registers. However, considering the high frequency of recognition for skin diseases (eczemas), it is likely that the information in the ROD is also to some extent representative of the recognized (genuine) cases. As regards the importance of various disease categories, skin diseases (eczemas) ranked 1st (numerically) among both recognized and compensated cases, and were the most expensive. Therefore preventive activities are mandatory, and because of the high frequency of recognition, the data in the ROD may provide a basis for establishment of the most relevant preventive activities. For other disease categories, the frequency of recognition was low, and the utility and reliability of the data in ROD is in questionable. Therefore, in general, an improvement in the notification system is desirable, but a system that takes into account the many uncertain factors is extremely difficult to set up. Linking of the registers is in progress, and this will be useful during everyday situations.

Recurrent pityriasis rosea. New episodes every year for five years. A case report.

A case of recurrent pityriasis rosea in a 39-year-old woman is presented. She had her first attack of pityriasis rosea 5 years ago and new outbreaks followed every year, in the spring. Her husband had a severe attack of pityriasis rosea 6 years ago. All laboratory investigations were normal and no explanation for the many recurrences was found.

The efficacy of a moisturizer (Locobase) among cleaners and kitchen assistants during everyday exposure to water and detergents.

Workers exposed to various irritants are widely advised to use moisturizers. To evaluate the efficacy of a moisturizer (Locobase), we studied 111 cleaners and kitchen workers during everyday exposure to water and detergents. All took part in a standardized interview. After randomization, 1/2 the workers (n = 56) used Locobase during a period of 2 weeks (period L), followed by a period without any emollient (period C), or vice versa (n = 55). Clinical assessment and measurements of the skin surface temperature, electrical capacitance and transepidermal water loss (TEWL) were performed on the fingers, hands and arms on entry to the study, after 2 weeks and 4 weeks, or at drop out. The final evaluation showed that 70 (63%) were able to complete the study; 23 (21%) completed period L, but withdrew from period C after a mean of 6 days because of progressive dryness of the skin and eczema; and 12 (11%) were excluded because they used topical corticosteroids or emollients. The remaining 6 (5%) participants were lost to follow-up. Clinically, we observed a significant increase in dryness (p < 0.001) during periods of no treatment (period C), and normalization of the skin texture during use of Locobase. Clinical observations were confirmed by statistically significant differences (p < 0.001) in the electrical capacitance (epidermal hydration), which decreased during period C and increased to pre-study values during period L. No significant differences were found in skin temperatures and TEWL rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Skin physiological changes in employees in the fish processing industry immediately following work. A field study.

In order to explain the complaints of dry skin after work among employees in the fish processing industry, we followed the skin blood flow (SBF), skin surface temperature, transepidermal water loss (TEWL) and electrical capacitance on the volar aspect of the 3rd finger in 10 fillet workers, where measurements were performed just at the end of a working day and during the next hour. The results were compared with 10 normal controls. During work, a low SBF, temperature and TEWL, and a high capacitance were found. After work, the SBF, temperature and TEWL increased to values above normal within 10-15 min, while the electrical capacitance decreased to subnormal values. A positive relation was demonstrated between skin temperature and TEWL, negative relations between temperature and capacitance, and between capacitance and TEWL. Our results in this field study confirm our clinical findings among workers in the fish processing industry: low occurrence of chapping and eczema during work and the development of dry skin after work.

The relationship between skin surface temperature, transepidermal water loss and electrical capacitance among workers in the fish processing industry: comparison with other occupations. A field study.

A field study among workers in the fish processing industry (n = 143) was performed to obtain information about skin surface temperature, transepidermal water loss (TEWL), and electrical capacitance and their relationships during work. The skin temperature, TEWL and electrical capacitance were measured on the fingers, hands and forearms. A linear positive relation was found between the temperature and TEWL (in all measured areas), a linear negative relation between the temperature and capacitance (fingers and palms), and a linear negative relation between the capacitance and TEWL (fingers). The results on the fingers among workers in the fish processing industry were compared with results among metal workers (n = 52), cleaners (n = 30), gut cleaners (n = 25), nurses (n = 16), office workers with indoor climate syndrome (n = 20) and normal controls (n = 29). A linear positive relation was found between the respective temperature-TEWL values and a linear negative relation between the respective temperature-capacitance values in the various groups. Furthermore the slope of the temperature-TEWL relations was identical in all groups. Therefore, differences in TEWL levels (comparison at the same temperature) between the respective groups and controls and between the various groups might indicate damage to the skin barrier caused by contact with different irritants and chemicals. However, differences in environment-related variables in the various occupations might also affect TEWL levels. This field study demonstrates, from a practical point of view, how the skin temperature affects TEWL in the various occupations and, as a new point, how sensitive capacitance is to changes in skin temperature. Seasonal variation in TEWL and capacitance was demonstrated among workers in the fish processing industry, with a low TEWL and a high capacitance during summer when the workload is lower.