Radiotherapy with soft X-rays in Dupuytren's disease - successful, well-tolerated and satisfying.

BACKGROUND: Up to present no curative treatment is known for Dupuytren's disease (DD). Surgery remains the most common treatment but lack of long-term efficacy and complications limit this therapeutic option. OBJECTIVE: In a retrospective analysis, the results of radiotherapy with soft X-rays in the treatment of DD were evaluated. METHODS: A total of 206 patients (297 affected hands) with DD were included. Radiation therapy was carried out with soft X-rays. A structured questionnaire considering patient and disease characteristics and effects of radiotherapy was evaluated after a median follow-up time of 40 months. RESULTS: Ninety-three (45%) of the 206 treated patients were reported on a regression of symptoms after radiation. No further disease progression (including patients with regression) was present in 165 patients (80%). Satisfaction with the therapy was expressed with an average score of 7.9 points (visual analogue scale, 0 = not satisfied, 10 = extremely satisfied). Subjective therapeutic effects for 426 nodules and/or cords showed a reduction of 92 nodules and/or cords. CONCLUSION: In 206 DD patients further disease progression was stopped in most patients. Radiotherapy proved to be well-tolerated, successful and satisfying for the patients.

Onychogryphosis in elderly persons: an indicator of long-standing poor nursing care? Report of one case and review of the literature.

A 92-year-old immobilized white woman under the daily nursing care of a private ambulatory nursing service displayed acquired deformities of the toenails resembling a ram's horn. In light of a rapidly growing elderly population, this case report illustrates the need for close monitoring of the quality of care that nursing services provide to older persons. In addition, it reviews the clinical aspects of onychogryphosis, as well as its pathomechanisms and treatment options.

Subcutaneous oleomas induced by self-injection of sesame seed oil for muscle augmentation.

This case presentation describes a 48-year-old man who experienced subcutaneous nodules 9 months after self-injection of sesame seed oil into the pectoral area for muscle augmentation. This procedure was reported by our patient to be frequently performed in the body-building and fitness scene. Ultrasound imaging showed multiple, low reflecting round nodular areas of up to 1 cm diameter in both breasts. Excision of a representative nodule revealed a cyst filled with oily material, surrounded by granulomatous tissue. This case report demonstrates an unusual side effect of augmentation measures in body-builders.

[Squamous epithelial carcinoma-associated necrolytic migratory erythema]. / Plattenepithelkarzinom-assoziiertes nekrolytisches migratorisches Erythem.

A 59-year-old Caucasian man suffered from persistent disseminated necrolytic skin lesions for 8 months. They failed to respond to a variety of therapeutic regimens but then cleared spontaneously within a few days. After one week an invasive squamous cell carcinoma of the hypopharynx became clinically apparent. At autopsy, the expected glucagonoma often associated with necrolytic migratory erythema was not found.

Diagnostic value of PCR for detection of Borrelia burgdorferi in skin biopsy and urine samples from patients with skin borreliosis.

Skin biopsies of 36 patients with erythema migrans and acrodermatitis chronica atrophicans (ACA) before therapy and those of 8 patients after therapy were examined for Borrelia burgdorferi DNA by PCR. Skin biopsies of 27 patients with dermatological diseases other than Lyme borreliosis and those of 10 healthy persons were examined as controls. Two different primer sets targeting 23S rRNA (PCR I) and 66-kDa protein (PCR II) genes were used. PCR was performed with freshly frozen tissue (FFT) and paraffin-embedded tissue (PET). For FFT specimens of erythema migrans, 73% were positive by PCR I, 79% were positive by PCR II, and 88% were positive by combining PCR I and II. For PET specimens, PCR was less sensitive (PCR I, 44%; PCR II, 52%). For FFT specimens of ACA, PCR I was positive for two of five patients and PCR II was positive for four of five patients. B. burgdorferi was cultured from 79% of the erythema migrans specimens but not from any of the ACA lesions. Elevated B. burgdorferi antibodies were detected in sera of 74% of erythema migrans patients and 100% of ACA patients. All urine samples were negative by PCR II, whereas PCR I was positive for 27%. However, hybridization of these amplicons was negative. Sequencing of three amplicons identified nonborrelial DNA. In conclusion, urine PCR is not suitable for the diagnosis of skin borreliosis. A combination of two different primer sets achieves high sensitivity with skin biopsies. In early erythema migrans infection, culture and PCR are more sensitive than serology.

Systemic antifungal treatment of children with terbinafine.

BACKGROUND: At present, griseofulvin is the only licensed drug for oral treatment of dermatophyte infections in children. OBJECTIVE: Children were treated with the fungicidal allylamine terbinafine. Efficacy and tolerability were evaluated. METHODS: Fifteen children (14 months to 11 years old, below 40 kg body weight) with culture-confirmed tinea capitis or tinea corporis were systemically treated with terbinafine. Five children suffered from tinea capitis, 6 from tinea corporis and 4 from a combined infection of the scalp and body. As causing agents Trichophyton violaceum (5), Microsporum canis (8) and Trichophyton mentagrophytes (2) were isolated. RESULTS: Mycological and clinical cure was achieved in all children after oral treatment with terbinafine for 4-8 weeks. Cure after discontinuation of therapy could be observed in 13 children. Two children with tinea capitis caused by M. canis relapsed within 1-2 months after the end of therapy. The overall tolerability of terbinafine in children was good; 1 child suffered from acute urticaria during treatment, which might be related to the medication. CONCLUSIONS: The applied therapy regimes were effective in most cases. In scalp infections by M. canis, the children should be treated for more than 4 weeks or with a higher dose. To find the optimal dosage and treatment periods for children, further prospective studies are necessary.

Sudeck's atrophy in Lyme borreliosis.

A patient with disseminated Lyme borreliosis is reported. The patient suffered from erythema migrans and radicular pain. Serologic tests routinely performed (IFT, ELISA, Western blots with different strains and Borrelia-LTT) were negative. However, Borrelia burgdorferi (genotype Borrelia afzelii) was cultivated from a skin biopsy. Western blot with the patient's isolate and sera showed strong reactivity only with the 60 kDa protein. In spite of immediate diagnosis and intravenous antibiotic treatment according to current recommendations he developed pain in the right ankle, which was resistant to further antibiotic and anti-inflammatory therapy. Sudeck's atrophy was diagnosed by X-ray. Treatment with calcitonin brought immediate relief from pain and led to radiographically demonstrable recalcification.

Cross-reactive proteins of Borrelia burgdorferi.

The specificity of serological tests for Lyme borreliosis is impaired by cross-reacting antibodies. In order to select antigens for more specific tests, specific and cross-reactive proteins of Borrelia burgdorferi must be identified. Therefore, to analyze cross reactions of Borrelia burgdorferi with other bacteria, rabbit immune sera against heterologous bacteria (Borrelia hermsii, Treponema pallidum, Treponema phagedenis, Leptospira interrogans (serogroup grippotyphosa), Neisseria meningitidis, Haemophilus influenzae, Yersinia enterocolitica (serotypes O3 and O9), Campylobacter jejuni, Listeria monocytogenes O1, Pseudomonas aeruginosa, Escherichia coli, Salmonella typhimurium, Shigella flexneri and Legionella micdadei) were examined by Western blot using Borrelia burgdorferi as antigen. Broad cross reactivity was shown for Borrelia proteins of the 60-75 kDa range. Other broadly cross-reacting proteins were at the level of p40, p33 and two proteins in the range of 20 kDa. Some of the cross reactions were eliminated by absorption of the sera with Treponema phagedenis. The absorbed antibodies were directed mainly against bands at the level of p33 and bands of the 60 to 75 kDa range. Showing the lowest potential for cross reactivity, p100, p41, OspA and pC seem to be the most suitable antigens for serodiagnosis. In contrast to p100 and OspA, however, p41 and pC showed cross reactivity with immune sera against bacteria not belonging to the genus Borrelia.