[The diagnosis of deep venous thromboses of the leg using a new rapid test (SimpliRED)]. / Diagnostik tiefer Beinvenenthrombosen mittels eines neuen Schnelltests (SimpliRED).

PURPOSE: Evaluation of sensitivity and specificity of a bed-side test in the diagnosis of deep-vein thrombosis compared to contrast phlebography. METHODS: 122 patients, referred for phlebography, underwent bedside testing (SimpliRED) for detection of deep vein thrombosis. Contrast phlebography was confirmed immediately afterwards. SimpliRED provides a clearly visible agglutination of the patient's red blood cells in the presence of elevated levels of crosslinked fibrin derivatives (D-dimer) in the sample, being specific for fibrin breakdown. RESULTS: In 37 (30.3%) patients deep vein thrombosis could be confirmed. An abnormal D-dimer test was found in 35 of the 37 patients with thrombosis (sensitivity: 94.6%). Two patients who had not been identified by agglutinin testing, showed an isolated calf thrombosis in small muscle veins (< 2 cm in diameter) not requiring treatment. 55 of 85 patients without thrombosis in phlebography were stated correctly by SimpliRED (specificity: 64.7%). CONCLUSION: All thrombotic disorders in the leg with the need for further treatment were identified correctly. SimpliRED is a very sensitive test with moderate specificity in the diagnosis of deep vein thrombosis. Therefore, further invasive testing is needed only in such patients where the D-dimer test is abnormal. A false positive result of the bed-side test may be non-specific or due to elevated levels of fibrin split products, if the coagulation system is activated in several other conditions.

Influence of medical compression stockings on venolymphatic drainage in phlebologically healthy test persons and patients with chronic venous insufficiency.

The goal of this study was to investigate the influence of medical compression stockings on venolymphatic drainage in phlebologically healthy test persons and patients with chronic venous insufficiency. Using this new method, the outflow of an intradermally injected sodium fluorescein solution can be densitrometrically determined over a period of 60 min. In an evaluation of the method carried out over 5 weeks with 4 test persons, the variation coefficient was 19.3%, indicating a sufficient reproducibility. Concerning the effect of below-knee stockings (ankle pressure 30 mm Hg) on venolymphatic drainage, improvements of around 200 (p < 0.0001) and 250% were recorded for 10 healthy test persons (mean age 29.0 +/- 3.1 years) and 20 patients suffering from chronic venous insufficiency (classes 4 and 5; p < 0.001), respectively. The results lead us to conclude that (i) the method presented here enables a quantification of the venolymphatic drainage and (ii) that therapy with compression stockings, for both healthy test persons and patients suffering from chronic venous insufficiency, leads to a significant improvement of venolymphatic drainage.

Long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. Experience with 108 cases.

PURPOSE: The purpose of this study was to determine the technique and results of long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. METHOD: Long-term, indwelling setons were performed in 108 consecutive patients with low transsphincteric and intersphincteric anal fistulas. Progress and results of 73.1 percent of cases were assessed in a retrospective study. RESULTS: Therapy lasted for an average of 54.8 weeks; mean follow-up was 62 weeks. Relapse occurred in 3.7 percent of cases and incontinence in 0.9 percent. Average period spent in a hospital was 0.3 days/case. CONCLUSIONS: A long-term, indwelling seton is a good alternative to primary surgical treatment of low transsphincteric and intersphincteric anal fistulas. Relapse quota is comparable with that of primary surgically treated cases; incontinence is rarer with long-term, indwelling seton. Complete treatment can generally be performed in the outpatient department. One disadvantage is that therapy takes much longer than cases treated by primary surgery.

[Angiokeratoma corporis diffusum universale (Fabry disease)]. / Angiokeratoma corporis diffusum universale (Morbus Fabry).

Fabry's disease (Angiokeratoma corporis diffusum) is a rare X-chromosome linked recessive disorder belonging to the group of sphingolipoidoses. The basic defect involves the gene encoding alpha-galactosidase. Because this enzyme is responsible for decomposition of glycosphingolipids, its deficiency results in their accumulation in endothelial and smooth muscle cells. With time, generalized angiokeratomas, paresthesias, renal and cardiac insufficiency and cerebrovascular complications develop. We report a patient who in addition to the well-described findings also showed unique nail fold capillary changes not described so far. Analysis of serum concentration of alpha-galactosidase identified three female heterozygous carriers in the patient's family.

[Chronic venous insufficiency]. / Die chronisch-venöse Insuffizienz.

In severe chronic venous insufficiency (CVI) the fascia cruris is increasingly involved in the pathological process. The resulting loss of compliance as a consequence of altered fascia texture leads to increased pressure in the compartments of the lower extremity, followed by reduced circulation. Arteries and nerves, which penetrate the fascia along with insufficient perforating veins, are damaged through the increased pressure and are therefore functionally impaired. Accordingly many pathological changes in the crural ulcer have their anatomical substrate here. The microcirculation is distributed by either primary varicosis with secondary insufficiency of the deep veins or by primary insufficiency of the deep venous system as seen in a post-thrombotic syndrome. Subsequent therapy should be based on this knowledge and therefore consists of medication and basic physical therapy along with dissection of the perforating veins-fasciotomy and fasciectomy combined with plastic surgery. All of the therapeutic measures have to take the stage of the CVI into consideration. In order to eliminate the insufficient perforating veins and to perform fasciotomy the endoscopic approach is considered the state of the art. In extreme cases, only fasciectomy combined with plastic surgery can lead to durable healing.

A new method for assessing the gloss of human skin.

A new method for an objective assessment of the gloss of human skin is presented. The reflectometric measuring set-up complies with DIN 67530. The principle of this new method is based on a contactless determination of the skin's reflection of light from a tungsten filament lamp, recorded at an angle of 60 degrees by a silicon photocell. In a comparative study with 30 test persons it was discovered that the forehead, with 2.70 standardised reflectometer units (RU; SD +/- 0.59 RU), displayed a significantly higher gloss than the lower arm (1.99 RU, SD 0.28 RU, p < 0.0001). In an investigation into the influence of four different cream bases on the skin gloss it could be determined that the value depends on the percentage of grease, the water concentration and the consistency of the respective base. The method presented permits a fast, contactless, randomly repeatable objective assessment of skin gloss. Since the acceptance of cosmetics and pharmaceutical products depends not least on their skin gloss effect, this method can provide valuable information when estimating the success of old and new products.

[Modification of the flexibility of the upper and lower ankle joint by medical compression stockings]. / Beeinflussung der Beweglichkeit im oberen und unteren Sprunggelenk durch medizinische Kompressionsstrümpfe.

Using a special measurement equipment the motility range of the ankle joint and the talo-calcaneo-navicular joint in healthy young volunteers was compared with and without compression hosiery. There was no limitation in joint motility using the stockings of moderate compression (german compression class 1 and 2) but a reduced motility using strong compression hosiery (german compression class 3 and 4) was found especially in the ankle joint. This difference was significant in the products of two manufacturers.

Photosensitivity reaction to intravenously administered fluorescein.

Sodium fluorescein is an organic dye widely used as a diagnostic aid. This article reports a case of a photosensitivity reaction associated with intravenous administration in a healthy volunteer. To our knowledge, this is the 1st case of a photosensitivity reaction of the immediate type due to fluorescein reported in the literature, which probably indicates its very low incidence. The literature on photosensitization to fluorescein is reviewed.

["Spatial shift alignment (SSA)"--a new method for determining blood flow velocity in video capillary microscopy]. / Das "Spatial Shift Alignment (SSA)"--eine neue Methode zur Bestimmung der Blutflussgeschwindigkeit in der Video-Kapillarmikroskopie.

A new technique (spatial shift alignment [SSA]) for measuring capillary blood velocity in human capillaries in the skin is described. A capillaroscopic image is digitized by means of a frame grabber. Within the lumen of a suitable capillary limb a region of interest known as a slot is placed. At a frame frequency of 25 per second, this slot is copied in a free part of the frame grabber store along a horizontal axis. A static space-time image with light diagonal bands representing the plasma gaps in their passage through the capillary limb is obtained. By determining the gradient of the diagonal bands, a measure of the capillary blood velocity is obtained. The SSA system was validated by means of a simulated model using known fixed velocities between 0 and 1.0 mm/sec (r = 0.979, n = 24). The procedure can be employed with any image processing systems, and enables continuous monitoring of the velocity measurements. Since it is time-saving and just as accurate as the frame-to-frame method, SSA could be widely applied to the measurement of blood cell velocity in capillaroscopy.

Capillary changes in angiokeratoma corporis diffusum Fabry.

We report on capillary changes on the Sulcus matricis unguis in a patient with an established angiokeratoma corporis diffusum Fabry. A fasciculated ramification of the capillary in 2-5 loops, which is not found in healthy individuals and that until now has solely been described in patients with vasculitis, was detected. The question now arises whether these are initial changes in the disease which later lead to manifested angiokeratomas. Further investigations will show if, and to what extent, these observations can contribute to further clarification of the developmental method of acroparaethesiae, which are part of the principal signs of Morbus Fabry.

[Painful cutis marmorata teleangiectatica congenita]. / Schmerzhafte Cutis marmorata teleangiectatica congenita.

A 39-year-old woman with cutis marmorata telangiectatica congenita (CMTC) on the back presented with a 5-year history of pain in the involved area which initially occurred only on touch and cold exposure but was ultimately virtually constant. Histological examination of a skin biopsy specimen revealed an increased number of nerve fibres. The phlebectatic subcutaneous veins were demonstrable by NIR (near infrared) venoscopy.

[Eye changes in acanthosis nigricans maligna--possible effect of growth factors in the etiopathogenesis of this paraneoplastic disease picture]. / Augenveränderungen bei Acanthosis nigricans maligna--möglicher Einfluss von Wachstumsfaktoren in der Atiopathogenese dieses paraneoplastischen Krankheitsbildes.

A 64-year-old white male presented to our hospital with hyperplastic tarsal and to a lesser degree bulbar conjunctivae. Approximately one month later the full clinical picture of acanthosis nigricans maligna developed. In addition to ectropia of the lower eyelids he showed madarosis; neither the linea grisea nor the lacrimal points were discerneable. On gastroscopy a diffusely growing gastric adenocarcinoma adjacent to the cardia was found and later confirmed histopathologically. The computertomography of the abdomen demonstrated one solitary metastasis to one parapancreatic lymphnode. It is generally assumed that in the course of paraneoplastic syndroms products secreted by the tumor induce changes in the target organs, e.g. the conjunctiva and the skin. In the presented case (1) southern blot analysis of the tumor tissue proved an increase of Epidermal Growth Factor-receptors, (2) immunohistochemistry showed prominent staining for Transforming Growth Factor-alpha. In conclusion, this case is suggestive of a possible link between growth factors and acanthosis nigricans maligna.

Further evidence that acanthosis nigricans maligna is linked to enhanced secretion by the tumour of transforming growth factor alpha.

The pathogenesis of cutaneous paraneoplastic syndromes is still under discussion. Since many of these syndromes, including acanthosis nigricans, are proliferative skin disorders it is believed that products secreted by the tumour stimulate the keratinocytes to proliferate. Growth factors like transforming growth factor alpha (TGF-alpha) are known to be highly mitogenic for keratinocytes in vitro. Here we report on a patient with a poorly differentiated gastric cancer and a full clinical picture of acanthosis nigricans characterized by diffuse hyperkeratosis and multiple papillomatous lesions of the skin with involvement of the conjunctivae. In Southern blot analysis of the tumour tissue from this patient amplification of the epidermal growth factor (EGF) receptor, the common ligand for TGF-alpha and EGF, was shown. Immunohistochemically, prominent staining was found throughout the tumour using anti-TGF-alpha antibodies. In a series of 25 investigated gastric tumour biopsies, four tumours showed amplification of the EGF receptor and one additional biopsy was positive for TGF-alpha. Since there is no other report describing the link between TGF-alpha and acanthosis nigricans, except that of Ellis et al. 1987, we present a new case suggesting a possible link between growth factors and acanthosis nigricans maligna.