Standard skin prick testing and sensitization to inhalant allergens across Europe--a survey from the GALEN network.

Skin prick testing (SPT) is the standard method for diagnosing allergic sensitization but is to some extent performed differently in clinical centres across Europe. There would be advantages in harmonizing the standard panels of allergens used in different European countries, both for clinical purposes and for research, especially with increasing mobility within Europe and current trends in botany and agriculture. As well as improving diagnostic accuracy, this would allow better comparison of research findings in European allergy centres. We have compared the different SPT procedures operating in 29 allergy centres within the Global Allergy and Asthma European Network (GA(2)LEN). Standard SPT is performed similarly in all centres, e.g. using commercial extracts, evaluation after 15-20 min exposure with positive results defined as a wheal >3 mm diameter. The perennial allergens included in the standard SPT panel of inhalant allergens are largely similar (e.g. cat: pricked in all centres; dog: 26 of 29 centres and Dermatophagoides pteronyssinus: 28 of 29 centres) but the choice of pollen allergens vary considerably, reflecting different exposure and sensitization rates for regional inhalant allergens. This overview may serve as reference for the practising doctor and suggests a GA(2)LEN Pan-European core SPT panel.

Effectiveness of LPG treatment in morphea.

BACKGROUND: The LPG technique, also known as Endermology treatment, is a noninvasive technique consisting of a tissue mobilization process in which a skin fold is created between two rollers, stretching the underlying tissue and mobilizing the fold. The LPG technique is very effective in treating scars. Because the lesions of morphea or circumscribed scleroderma are similar to atrophic scars, it seemed reasonable to treat them with a method proven helpful for scars. MATERIALS AND METHODS: We treated 17 lesions of 10 patients (four males and six females) with the diagnosis of morphea ranging in age from 17 to 78 years (mean age 55 years) and investigated and documented the evolution of their lesions and changes in their quality of life. RESULTS: In all patients there was a large improvement in the clinical appearance of the lesions, the induration and the pain. Elasticity was particularly increased, not only based on clinical findings but also as documented with objective assessment. The acceptability of the treatment was good and the patients reported an improved quality of life. CONCLUSION: The LPG technique (Endermology) is an adjunctive treatment for morphea. It cannot eliminate the disease but can relieve the pain, soften the skin and improve the quality of life for these patients.

Human testicular mast cells contain tryptase: increased mast cell number and altered distribution in the testes of infertile men.

OBJECTIVE: To determine whether human testicular mast cells contain the potent fibroblast growth factor tryptase and to examine changes in mast cell morphology and intratesticular distribution in testes with normal spermatogenesis versus abnormal spermatogenesis. DESIGN: Retrospective evaluation of testicular biopsies with the use of immunohistochemistry, morphometry, and electron microscopy. SETTING: University research and clinical institutes. PATIENT(S): Infertile men (total of 24) with severe hypospermatogenesis, germ cell arrest syndrome, or Sertoli cell only syndrome, and men without pathologies. INTERVENTION(S): Diagnostic testicular biopsy. MAIN OUTCOME MEASURE(S): Location, number, and distribution of testicular mast cells. RESULT(S): All groups showed tryptase-positive mast cells. In specimens with normal spermatogenesis, mast cells were round and located mainly in the interstitial spaces close to Leydig cells. In germ cell arrest syndrome, a 2-fold increase was evident, and in Sertoli cell only syndrome, a >3-fold increase of tryptase-immunoreactive mast cells became evident. Moreover, there was a statistically significant shift of the cells from the interstitium to the tubular walls in Sertoli cell only syndrome and germ cell arrest syndrome. Mast cells in specimens of Sertoli cell only syndrome and germ cell arrest syndrome were heterogeneous, with rounded or elongated shapes and signs of degranulation. The thickness of the tubular walls was doubled in specimens of germ cell arrest syndrome and Sertoli cell only syndrome in comparison with normal specimens, and this increase was positively correlated with the number of mast cells in these patients. CONCLUSION(S): Our results suggest that mast cell products, including the potent fibroblast growth factor tryptase, are involved in the thickening of the tubular wall and other changes in infertile testes.

Evidence for catecholaminergic, neuronlike cells in the adult human testis: changes associated with testicular pathologies.

Neuronlike, catecholaminergic cells expressing tyrosine-hydroxylase (TH) have recently been found in the testis of a nonhuman primate species, the rhesus monkey. We examined whether neuronlike cells are present in the human testis. To this end, we first determined if the genes for TH and for a voltage-activated sodium channel (NaCh), a prerequisite for neuronal excitability, are expressed in normal adult testes. Using an RT-PCR approach, cDNA clones, identical to the sequences of human TH and to the alpha subunit of a NaCh type, were isolated. Immunohistochemical methods localized the corresponding proteins in testicular biopsies from adult men (age range, 28-44 years) without testicular pathologies and from infertile patients with either Sertoli cell only (SCO) syndrome or severe hypospermatogenesis and germ cell arrest (GA). TH and NaCh antibodies, as well as antibodies recognizing dopamine-transporter protein, identified immunoreactive cells of mainly bipolar or occasionally multipolar, elongated phenotype in most, but not all, biopsies of each group (12 out of 23). The results were corroborated by identification of TH gene expression by RT-PCR approaches in biopsies. Immunoreactive cell bodies, as well as nerve fibers, were more readily detected in SCO and GA biopsies. This was quantified after immunohistochemically visualizing all testicular neuronal elements, cell bodies, and fibers, with a neurofilament 200 (NF-200) monoclonal antibody in one set of randomly selected sections from all biopsies. We found significantly increased NF-200-immunoreactive cell bodies and fibers in SCO-syndrome and GA biopsies. These results show the existence of an as yet unknown testicular catecholaminergic neuronlike cell type in the human testis. This cell type may complement and act in concert with the well-known testicular sympathetic innervation. The increase of both "intrinsic" (neuronal cells) and "extrinsic" (nerve fibers) neuronal elements in pathological testicular biopsies suggests that the two parts of the human testicular nervous system may be involved in pathogenesis and/or maintenance of GA and SCO syndromes.

Birth of healthy children after intracytoplasmic sperm injection in two couples with male Kartagener's syndrome.

OBJECTIVE: To describe two cases in which intracytoplasmic sperm injection (ICSI) was successful for patients with infertility due to Kartagener's syndrome. DESIGN: Case report. SETTING: Private hospital for gynecology department of reproductive medicine, and university hospital center for andrology. PATIENT(S): Two couples with primary infertility due to Kartagener's syndrome in the male. INTERVENTION(S): ICSI. MAIN OUTCOME MEASURE(S): Pregnancy and birth after ICSI. RESULT(S): In both couples, ICSI was successful in the first cycle. The uncomplicated pregnancies resulted in the birth of three healthy children. One female and male/female twins. CONCLUSION(S): In couples with infertility due to Kartagener's syndrome in the male, ICSI has proved to be a successful therapy resulting in clinically healthy offspring. This knowledge may improve our understanding of the involvement of paternally inherited centrosomes, which nucleate microtubules, in human reproduction.

Design of an optimally-diagnostic skin test solution for diagnosis of sensitivity to timothy grass (Phleum pratense) pollen.

BACKGROUND: Although most of the common allergen extracts that are used for diagnosis of type 1 hypersensitivity are now well standardized, this gives no assurance that they are within the concentration range that gives the best chance of a true diagnosis. OBJECTIVE: The objective of this study was to identify the most appropriate concentration range of timothy grass pollen Phleum pratense extract to diagnose sensitivity to this pollen correctly through skin-testing. METHODS: Dilutions of a well-standardized extract were made and used to skin test "true' positive and "true' negative populations of subjects as identified by case history, challenge tests and radioallergosorbent test (RAST). Weal diameters were measured and the data were submitted to receiver operating characteristics (ROC) analysis. For any particular weal size cut-off, the optimal diagnostic concentration (ODC) range was thus calculated. RESULTS: A 3 mm weal diameter cut-off was chosen as an appropriate size for routine diagnosis. Therefore the ODC range at this diameter was used to establish a product target concentration and specification for formulation of the diagnostic reagent. This method of allergen extract standardization can lead to a true-biological unitage that can be used for labelling purposes. CONCLUSION: The optimum concentration range at which to formulate an allergen extract, in terms of an in vitro immunologically based assay, can be determined by carrying out ROC analysis of the results of clinical studies as described in this communication. Diagnostic units (DU), are now used by us for labelling of such final formulations which conveys the information that the product is at the most appropriate concentration for diagnosis.

[Therapy of the symptoms of "dry skin"]. / Therapie des Symptoms der "trockenen Haut".

The symptom of dry skin is seen in some skin diseases, in old people and under various physical and chemical influences. The main pathogenetic factor is the dehydratation of the corneocytes. Therefore waterprotective and waterbinding creams are used. All water-in-oil-emulsions and ointment basics are waterprotective. So called moisturizers are added to the ointments to improve the waterbinding capacity. One natural moisturizer is urea, which for instance is contained in Basodexan ointment. There are new therapeutic ways since the introduction of the liposomes. Liposomes represent longlasting and precisely applicable deposits for moisturizer and other active extracts.