[Affective mentalizing in Addictive Borderline Personality: A literature review]. / La mentalisation affective de la personnalité limite addictive : une revue de la littérature.

This literature review concerns affective mentalizing in borderline addictive personality. This concept postulates the group between addictions and borderline personalities may correspond to Personality Disorders (PDs). First, we will present conceptualizations and evaluations of affective mentalizing. The latter refers to one dimension of mentalization, a process by which an individual interprets his/her mental states and those of others. Lecours and Bouchard proposed a hierarchic model: the Élaboration verbale de l'affect (EVA). They also developed an empiric methodology: the Grille de l'élaboration verbale de l'affect (GEVA). The methodological approach of Lecours fulfils the requirements made by Cho-Kain, Gunderson and Luyten, involving a narrower operationalization of the mentalization concept through the evaluation of its dimensions. Conceptualizations and evaluations enabled focus on mentalization psychopathology. Fonagy and Bateman studied this latter in the subjects with PDs, particularly in Borderline Personality Disorders (BPD). We describe mentalization failure, its etiology and consequences in the BPD. Several forms of mentalization psychopathology are identified. Its etiology is largely environmental. Fonagy and Bateman developed the optimum developmental model of mentalization and referred to it to explain etiology of mentalization failure in BPD. Consequences of mentalization failure explicate its functioning. Mentalization may be considered as essential in their comprehension and their care. Research about mentalization of PDs does not integrate addiction as one comorbidity factor. However, Allen, Fonagy and Bateman describe a bidirectional interaction between mentalization failure and addiction. We propose to examine the mentalization of Borderline Addictive Personality. This concept groups addictions and borderline personalities in just one clinical entity other than their links of co-morbidities.

[Phototoxic and photoallergic reactions]. / Phototoxische und photoallergische reaktionen.

Many artificial or naturally occurring substances are included under the term photosensitizer. After ultraviolet (UV) exposure such agents can lead to increased photosensitivity and subsequently to phototoxic or photoallergic reactions in the skin. From clinical observations and comprehensive studies typical reaction patterns can be deduced which can clarify the difference between phototoxic and photoallergic dermatitis.An illuminated epicutaneous test based on conventional epicutaneous tests, the photopatch test, was developed as a screening method for identification of photosensitizers. The diagnostic specificity and sensitivity of the test is comparable to conventional epicutaneous testing. If possible photosensitizers do not cause any relevant reactions with the photopatch test, other test procedures, such as the photoprick, photoscratch and illuminated intracutaneous tests are available. If the actual photosensitizer is not the test substance but a metabolite of the test substance, a systemic photoprovocation test can be indicated.

[From hedgehogs to men. Zoophilic dermatophytosis caused by Trichophyton erinacei in eight patients]. / Von Igeln auf Menschen. Zoophile Dermatomykose durch Trichophyton erinacei bei 8 Patienten.

The hedgehog is an in Germany previously unrecognized source of human ringworm. Eight hedgehog caretakers from Göttingen and the surrounding area developed dermatophytosis caused by Trichophyton erinacei. Four patients who handled the animals without gloves developed lesions on the hands that were more in keeping with hand eczema, leading to a delay in diagnosis. The other caretakers who wore gloves presented with typical ringworm on the arms, the big toe, the back, the abdomen, and the thighs. Their typical clinical features led to an early diagnosis and treatment.

[Superficial X-ray therapy of lip cancer after chronic excessive sun exposure of a 47-year-old autistic painter]. / Röntgenweichstrahltherapie eines Unterlippenkarzinoms nach chronisch-exzessiver Sonnenexposition einer 47-jährigen autistischen Malerin.

A 47-year-old autistic painter developed lip cancer after chronic excessive sun exposure. As she feared sun withdrawal during inpatient surgical excision, she refused this first-line treatment and therefore received outpatient X-ray therapy. The reason why she developed premature lip cancer and refused to stay in a hospital and the way she illustrated her "sun addiction" in her pictures is presented. Two years later she was free of recurrence. She has remained a sun worshipper until now, but after X-ray therapy she used daily sunscreens with very high sun protection factors, which attenuated the actinic damage. Considering the specific personality of the autistic painter, outpatient radiation therapy was a good alternative to inpatient surgery.

[Toxic contact dermatitis from poison ivy in a private garden in Germany]. / Toxische Kontaktdermatitis auf Poison Ivy in einem Privatgarten in Deutschland.

A couple suffered for 5 years from recurrent eruptions with vesicles and bullae after contact with an unknown "climbing weed" in their private garden in Germany. After this plant was identified as poison ivy and eradicated, their skin problems were solved. This is the first report of poison ivy in this setting. Urushiols in poison ivy are not only strong allergens but also potent irritants. Negative patch tests in the husband suggest that the bullous dermatitis was a toxic reaction.

[Solar urticaria]. / Lichturtikaria.

Solar urticaria serves as a model to illustrate the photodiagnostic approach in rare photodermatoses and to demonstrate how patients can be effectively helped by prophylactic and therapeutic intervention. To accomplish these tasks, advanced knowledge and experience in photodermatology is required, along with equipment which is often available in specialized centers only. A list is attached listing the dermatology departments with photodiagnostic units in Germany, Austria, and Switzerland.

Itraconazole in the treatment of tinea capitis in children. Case reports with long-term follow-up evaluation. Review of the literature.

Although griseofulvin is considered the standard treatment of tinea capitis in children, alternatives are being investigated. Our purpose was to determine the efficacy of itraconazole for kerion and noninflammatory tinea capitis. An open label study was performed on five patients. It was planned to treat them with itraconazole until they were mycologically and clinically cured. A 28-112-day course of 100 mg itraconazole daily, combined with a topical antifungal treatment resulted in clinical and mycological cure in all children. One child stopped taking itraconazole after 28 days, before it was clinically cured, because of nausea. Nevertheless, this child also achieved clinical and mycological cure. No other side-effects were reported. In long-term follow-up evaluation of between 2 and 3.5 years no recurrence or reinfection was observed. There was complete regrowth of hair, even after kerion. These findings and the review of the literature suggest that itraconazole offers an alternative to griseofulvin for the treatment of tinea capitis in children, although it is more expensive and not approved by German state authorities for this indication.

The LuxS family of bacterial autoinducers: biosynthesis of a novel quorum-sensing signal molecule.

Many bacteria control gene expression in response to cell population density, and this phenomenon is called quorum sensing. In Gram-negative bacteria, quorum sensing typically involves the production, release and detection of acylated homoserine lactone signalling molecules called autoinducers. Vibrio harveyi, a Gram-negative bioluminescent marine bacterium, regulates light production in response to two distinct autoinducers (AI-1 and AI-2). AI-1 is a homoserine lactone. The structure of AI-2 is not known. We have suggested previously that V. harveyi uses AI-1 for intraspecies communication and AI-2 for interspecies communication. Consistent with this idea, we have shown that many species of Gram-negative and Gram-positive bacteria produce AI-2 and, in every case, production of AI-2 is dependent on the function encoded by the luxS gene. We show here that LuxS is the AI-2 synthase and that AI-2 is produced from S-adenosylmethionine in three enzymatic steps. The substrate for LuxS is S-ribosylhomocysteine, which is cleaved to form two products, one of which is homocysteine, and the other is AI-2. In this report, we also provide evidence that the biosynthetic pathway and biochemical intermediates in AI-2 biosynthesis are identical in Escherichia coli, Salmonella typhimurium, V. harveyi, Vibrio cholerae and Enterococcus faecalis. This result suggests that, unlike quorum sensing via the family of related homoserine lactone autoinducers, AI-2 is a unique, 'universal' signal that could be used by a variety of bacteria for communication among and between species.

[Black nails caused by Proteus mirabilis]. / Ungues nigri durch Proteus mirabilis.

Black nails caused by Proteus mirabilis were seen in a motor mechanic and in a petrol pump attendant. Proteus mirabilis is a gram-negative bacillus that generates hydrogen sulfide. This compound reacts with traces of metals in the nail plate such as zinc, nickel, cobalt, iron, manganese, tin, copper and lead. Metal sulfides blacken the nail plate. The protracted course of the discoloration over months corresponds to the slow reactions of metals with hydrogen sulfide. The disappearance of the blackening after topical treatment with chinosol, tincture of iodine and chloramphenicol solution supports the etiologic connection between black nails and Proteus mirabilis. Wet and dirty work encourages the colonisation of Proteus mirabilis between nail fold and nail plate.

[Actinic prurigo]. / Aktinische Prurigo.

The non-Native American type of actinic prurigo belongs to the group of rare idiopathic photodermatoses and therefore is often diagnosed with delay. The typical clinical and epidemiological features of actinic prurigo are described in a 10 year old girl. Detailed phototesting showed urticarial early onset and prurigo-like late onset reactions towards long-wave UVA. Repetitive photoprovocation with UVB induced delayed development of papules. HLA typing showed the typical association with HLA-DR4, in particular DRB1*0407. Treatment is usually extremely difficult and unrewarding. In this patient, the course was considerably improved by more intense physical photoprotection.

Depigmented hypertrichosis following Blaschko's lines associated with cerebral and ocular malformations: a new neurocutaneous, autosomal lethal gene syndrome from the group of epidermal naevus syndromes?

The lines of Blaschko represent one of the cutaneous patterns of mosaicism followed by various skin disorders. Developmental abnormalities affecting other tissues derived from the embryonic ectoderm and mesoderm are occasionally associated. We describe a 30-year-old man with depigmented, bilateral hypertrichosis and dilated follicular orifices following Blaschko's lines associated with cerebral and ocular malformations. The findings suggest a previously unreported neurocutaneous, autosomal lethal gene syndrome from the group of epidermal naevus syndromes.

[Erythrokeratodermia progressiva symmetrica Darier-Gottron with generalized expression]. / Erythrokeratodermia progressiva symmetrica Darier-Gottron mit generalisierter Ausprägung.

A mother and her son presented with erythrokeratodermia progressiva symmetrica Darier-Gottron. Both patients developed symmetrical erythematous and hyperkeratotic plaques on the extremities and face at the age of 6 months. At the age of 2 1/2 years the son suffered from rapid progression of the disease to involve the entire skin. The disease of his mother had shown a similar course, however, with spontaneous regression at the age of 10 years. The clinical features of this generalized condition were identical to congenital lamellar ichthyosis. Light microscopy was non-specific with orthohyperkeratosis, focal parakeratosis and acanthosis. Electron microscopy revealed numerous keratinosomes in the stratum granulosum, keratinosome-derived lamellae in the intercellular space and partly augmented keratohyalin with clumping. In the stratum spinosum short tonofilament bundles with clumping were remarkable. The child experienced a significant and persistent improvement with systemic retinoids. His mother's disease was successfully controlled with intermittent retinoid therapy. With the clinical and ultrastructural criteria presently available, an unambiguous differentiation between erythrokeratodermia progressiva symmetrica, usually a localized disorder of keratinization, however with intermittent generalization, and other disorders of keratinization seems difficult.

Dioxopromethazine-induced photoallergic contact dermatitis followed by persistent light reaction.

BACKGROUND: Although photosensitivity after photoallergy to topical phenothiazine antihistamines is well known, there have been no previous reports of dioxopromethazine inducing this phenomenon. OBJECTIVE: A housewife used 0.5% dioxopromethazine in Prothanon gel for palpebral pruritus and developed severe dermatitis of the lower eyelids with spread to the sun-exposed areas. METHODS: The minimal erythema doses and the minimal infiltrate doses for ultraviolet A (UVA) and ultraviolet B (UVB) were established before photopatch testing and at intervals up to 497 days thereafter. Test sites were read up to 144 hours after irradiation. Photopatch testing was performed with Prothanon gel, dioxopromethazine hydrochloride 0.001% to 0.5%, and the standard photopatch test tray (Hermal/Trolab). For patch testing, various series of the German Contact Dermatitis Group were applied. RESULTS: Minimal erythema doses for UVA were diminished before photopatch testing and at intervals up to 500 days after Prothanon gel was discontinued. Exposure to UVB provoked abnormal delayed infiltrated reactions. Clinically the photosensitivity persisted within this period. Photoallergic reactions were seen with Prothanon gel, dioxopromethazine hydrochloride 0.005% to 1.0%, and promethazine hydrochloride 0.1%. The patient gave positive patch test reactions to various fragrance materials, balsam of Peru, costus oil, and propylene glycol. CONCLUSION: Because topical dioxopromethazine may cause photoallergic contact dermatitis followed by long-lasting photosensitivity even after contact has been discontinued, its withdrawal from the market is recommended.

Crystal structure of the IIB subunit of a fructose permease (IIBLev) from Bacillus subtilis.

The bacterial phosphoenolpyruvate-dependent phosphotransferase system (PTS) mediates both the uptake of carbohydrates across the cytoplasmic membrane and their phosphorylation. During this process, a phosphoryl group is transferred from phosphoenolpyruvate via the general PTS proteins enzyme I, HPr and the sugar-specific components IIA, IIB to the transported sugar. The crystal structure of the IIB subunit of a fructose transporter from Bacillus subtilis (IIBLev) was solved by MIRAS to a resolution of 2.9 A. IIBLev comprises 163 amino acid residues that are folded into an open, mainly parallel beta-sheet with helices packed on either face. The phosphorylation site (His15) is located on the first loop (1/A) at one of the topological switch-points of the fold. Despite different global folds, IIBLev and HPr have very similar active-site loop conformations with the active-site histidine residues located close to the N terminus of the first helix. This resemblance may be of functional importance, since both proteins exchange a phosphoryl group with the same IIA subunit. The structural basis of phosphoryl transfer from HPr to IIAMan to IIBMan was investigated by modeling of the respective transition state complexes using the known HPr and IIAMan structures and a homology model of IIBMan that was derived from the IIBLev structure. All three proteins contain a helix that appears to be suitable for stabilization of the phospho-histidine by dipole and H-bonding interactions. Smooth phosphoryl transfer from one N-cap position to the other appears feasible with a minimized transition state energy due to simultaneous interactions with the donor and the acceptor helix.

Contact and photocontact sensitivity to sunscreens. Review of a 15-year experience and of the literature.

This review summarizes published and unpublished data of our 15-year experience with sunscreen allergy and photoallergy. From 1981-1996, 402 patients with suspected clinical photosensitivity were patch and photopatch tested with the commercial sunscreens and facial cosmetics that they had used and with chemical UV absorbers, fragrance materials, preservatives, and emollients. 80 patients (20%) (28 men, 52 women) demonstrated allergic and/or photoallergic contact dermatitis to 1 or more UV absorber(s). In 47 patients with photodermatoses or photo-aggravated dermatoses and in 33 subjects with normal photosensitivity, 91 allergic and 84 photoallergic reactions to UV filters were observed. Over the years sunscreens were added to the test series, which since 1989 comprised the following 10 UV absorbers and which induced allergic (a) and photoallergic (pa) reactions (number, type of reaction): 4 UVA absorbers--isopropyldibenzoylmethane (30a/32pa); butyl methoxydibenzoyl-methane (15a/13pa); benzophenone-3 (3a/9pa); benzophenone-4 (0a/0pa); and 6 UVB absorbers--PABA (2a/2pa); octyl dimethyl PABA (1a/2pa); methylbenzylidene camphor (32a/5pa); octyl methoxycinnamate (3a/4pa); isoamyl p-methoxycinnamate (4a/10pa); and phenylbenzimidazole sulfonic acid (1a/7pa). The frequent (photo)sensitization to isopropyldibenzoylmethane was the reason that its production was discontinued in 1993. 47 patients reacted to fragrance materials, 11 to preservatives and 2 to lanolin alcohol. These constituents were contained in the commercial sunscreens and cosmetics that they had used. Continuous revision of the UV absorber photopatch test series was necessary to be closer to the real frequency of exposure and of reported (photo)allergy to newer sunscreens. Clinicians should consider contact and photocontact allergy, especially in patients with photodermatoses and photo-aggravated dermatoses, and they should perform photopatch testing. Once the culprit has been identified, its INCI (International Nomenclature Cosmetic Ingredients) designation should be given to the patient, who must be warned to avoid products containing the (photo)allergen.

Olaquindox-induced airborne photoallergic contact dermatitis followed by transient or persistent light reactions in 15 pig breeders.

There have been no previous reports of photosensitivity following photoallergy to airborne olaquindox in a large group. 15 pig breeders, with photo-distributed dermatitis related to olaquindox dust, were investigated to study the nature, promoting factors, and course of this disease. Minimal erythema doses for UVA and UVB were established before photopatch testing and at intervals thereafter. All patients presented with olaquindox-induced photoallergy. In 14 cases, this was followed by prolonged increased sensitivity to UVA. 7 patients also displayed an increased sensitivity to UVB. 13 farmers came into contact with olaquindox in mineral feed (1000 mg/kg) and only 2 in final feed (50 mg/kg). 8 patients avoided further contact with olaquindox because of warnings in the media. Allergies and photoallergies to other occupational substances preceded or followed olaquindox (photo)allergy. Because of their increased sensitivity to light, most of these farmers used sunscreens, and 2 of them developed (photo)allergy to UV-absorbers. As a result of our studies, we recommend photopatch testing for olaquindox in pig breeders with photo-distributed dermatitis. This would enable the early recognition of photoallergy to olaquindox and the prevention of persistent light reaction.