Atopy patch testing with aeroallergens in a large clinical population of dermatitis patients in Germany and Switzerland, 2000-2015: a retrospective multicentre study.

BACKGROUND: The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. OBJECTIVE: To evaluate the reaction frequency and the reaction profiles of 10 until mid-2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. METHODS: A retrospective data analysis of patients with suspected aeroallergen-dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology-associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. RESULTS: The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. CONCLUSION: The aeroallergen patch test is a useful add-on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series.

Contact allergy induced by bisphenol A diglycidyl ether leachables from aluminium tubes for pharmaceutical use.

BACKGROUND: Aluminium tubes for pharmaceutical use are internally lacquered with epoxy resins (ER) based on bisphenol A diglycidyl ether (BADGE). Recently, it was shown that remnants of ER polymerization like BADGE are extractable from epoxy-based coatings of commercially available tubes and may leach into semi-solid drug preparations. We aimed to evaluate the safety of BADGE-contaminated macrogol ointments in individuals sensitized to ER based on BADGE by use tests. METHODS: Repeated open application testing (ROAT) in 11 patients sensitized to ER based on BADGE with BADGE in macrogol ointments (3 mg/kg; 30 mg/kg, equivalent to BADGE concentration determined in macrogol ointment after storage in a commercially available tube; 300 mg/kg). RESULTS: The 30 mg/kg BADGE ointment elicited reactions in three patients, and another three patients reacted to 300 mg/kg BADGE ointment. No reactions to the vehicle control and 3 mg/kg BADGE were observed. CONCLUSIONS: Elevated BADGE concentrations in ER-coated aluminium tubes pose a risk of developing contact dermatitis to patients sensitized to ER based on BADGE. Quality standards are deemed necessary for the production of ER-coated aluminium tubes intended for pharmaceutical use and should consider the results of the present ROAT study.

Chronic stress experience and burnout syndrome have appreciable influence on health-related quality of life in patients with psoriasis.

BACKGROUND: Psoriasis has a negative impact on health-related quality of life (HRQoL) and may favour mental comorbidity. OBJECTIVE: To investigate the contribution of chronic stress and burnout experience to HRQoL and how mental health influences the efficacy of an inpatient rehabilitation measure in psoriasis patients. METHODS: Eighty-four psoriasis patients taking part in a 3-week inpatient rehabilitation measure participated in the study. Severity of psoriasis was assessed with the Psoriasis Area and Severity Index (PASI) and by patients' self-evaluation at the beginning and end of treatment. The following aspects of mental health were explored using validated questionnaires. Symptoms of chronic stress and burnout experience: Trier Inventory for the Assessment of Chronic Stress (TICS) and Shirom Melamed Burnout Measure (SMBM). Symptoms of depression: depression scale of the Patient Health Questionnaire in the German version (PHQ-D). HRQoL: Dermatology Life Quality Index (DLQI) and Short Form Health Survey-8 (SF-8). RESULTS: Linear regression analyses revealed that chronic stress, burnout experience and perceived symptom severity but not clinician-assessed severity of psoriasis had independent negative effects on HRQoL. Patients who achieved a PASI reduction of <75% at discharge from the rehabilitation measure had lower baseline QoL and showed more symptoms of depression, chronic stress and burnout than patients who achieved a PASI improvement of ≥75. CONCLUSION: Chronic stress and burnout have appreciable influence on HRQoL and may adversely affect treatment success in psoriasis patients. Our data underscore the importance of a multidimensional approach in the management of psoriasis.

Tertiary individual prevention improves mental health in patients with severe occupational hand eczema.

BACKGROUND: Occupational hand eczema (OHE) is associated with impaired health-related quality of life (QoL) and mental distress. Interdisciplinary inpatient rehabilitation measures in the framework of tertiary individual prevention (TIP) offered by the German employers' liability insurance associations include dermatological treatment, education and psychological interventions. OBJECTIVE: To investigate the effects of interdisciplinary inpatient rehabilitation in the framework of TIP on mental health in patients with severe OHE and the relationships between recovery of OHE and improvement of mental health and QoL. METHODS: A total of 122 patients participated in the study. A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale (HADS-D), the Dermatology Life Quality Index (DLQI), the Short Form Health Survey-36 (SF-36) and the Trier Inventory for the Assessment of Chronic Stress (TICS) was applied at the time of admission (T1) and 3 weeks after dismissal (T2). Severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index (OHSI). RESULTS: All parameters improved significantly from T1 to T2. A relationship was established between the improvement of QoL and recovery of OHE, while there was no such relationship between the improvement of mental distress and improvement of OHE. Nonresponders had significantly more cumulative days of sickness at T1. CONCLUSIONS: Our data underscore the importance of psychological interventions in addition to dermatological treatment in the framework of prevention measures for OHE. These measures should be applied at an early stage of OHE prior to the occurrence of sick leave.

[Cutaneous granulomatous reactions at botulinum neurotoxin A injection sites: First manifestation of systemic sarcoidosis]. / Granulomatöse Hautveränderungen an Botulinumtoxin-A-Injektionsstellen : Erstmanifestation einer systemischen Sarkoidose.

CASE REPORT: We report a case of granulomatous skin reaction after injection of an unknown botulinum neurotoxin (BoNT) A preparation. Four years after occurrence of skin lesions, systemic sarcoidosis became manifest. CONCLUSION: In addition to injection trauma, the BoNT A preparation may have acted as an immunogenic stimulus leading to cutaneous manifestation of sarcoidosis.

Severe occupational hand eczema, job stress and cumulative sickness absence.

BACKGROUND: Stress is known to activate or exacerbate dermatoses, but the relationships between chronic stress, job-related stress and sickness absence among occupational hand eczema (OHE) patients are inadequately understood. AIMS: To see whether chronic stress or burnout symptoms were associated with cumulative sickness absence in patients with OHE and to determine which factors predicted sickness absence in a model including measures of job-related and chronic stress. METHODS: We investigated correlations of these factors in employed adult inpatients with a history of sickness absence due to OHE in a retrospective cross-sectional explorative study, which assessed chronic stress (Trier Inventory for the Assessment of Chronic Stress), burnout (Shirom Melamed Burnout Measure), clinical symptom severity (Osnabrück Hand Eczema Severity Index), perceived symptom severity, demographic characteristics and cumulative days of sickness absence. RESULTS: The study group consisted of 122 patients. OHE symptoms were not more severe among patients experiencing greater stress and burnout. Women reported higher levels of chronic stress on some measures. Cumulative days of sickness absence correlated with individual dimensions of job-related stress and, in multiple regression analysis, with an overall measure of chronic stress. CONCLUSIONS: Chronic stress is an additional factor predicting cumulative sickness absence among severely affected OHE patients. Other relevant factors for this study sample included the 'cognitive weariness' subscale of the Shirom Melamed Burnout Measure and the physical component summary score of the SF-36, a measure of health-related life quality. Prevention and rehabilitation should take job stress into consideration in multidisciplinary treatment strategies for severely affected OHE patients.

[Applications for medical rehabilitation in the field of dermatology]. / Beantragung medizinischer Rehabilitation in der Dermatologie.

New rehabilitation guidelines and laws have been introduced to promote competition. As a result, the application procedures for rehabilitation measures have been reformed. Since 2007, the application procedure depends on the type of benefit (e.g. secondary or tertiary prevention) and the insurance provider (statutory health or pension insurance company). Thus in order to prescribe rehabilitation as a form of tertiary prevention payable by a statutory health insurance company, accredited doctors have to demonstrate that they have the necessary qualifications as stipulated by the rehabilitation guidelines. As before 2007, any accredited doctor may however apply for rehabilitation in the sense of tertiary prevention payable by a statutory pension insurance company, and for benefits associated with primary and secondary prevention payable by a statutory health insurance company, without providing corresponding proof of qualification. In addition, dermatologists should report occupational skin diseases to the statutory accident insurance using the "optimized dermatologist's report" which also allows them to recommend secondary and tertiary preventative measures. Every insurance-accredited dermatologist should understand the application process and the contents of preventative and rehabilitation measures to ensure their patients' right to participate.

Isolation of alpha-toxin-producing Staphylococcus aureus from the skin of highly sensitized adult patients with severe atopic dermatitis.

BACKGROUND: Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, alpha-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion. OBJECTIVES: To investigate the association between sensitization to inhalant allergens and skin colonization with alpha-toxin-producing S. aureus in AD. PATIENTS AND METHODS: We investigated 127 patients with AD, aged 14-65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens. RESULTS: Forty-eight of 127 patients were colonized with S. aureus, suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced alpha-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen. CONCLUSIONS: Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with alpha-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with alpha-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards alpha-toxin-producing S. aureus.

[Cooperation among clinics and practices. Integrated medical care in occupational dermatology]. / Neue Formen der Zusammenarbeit zwischen Praxis und Klinik. Integrierte Versorgung in der Berufsdermatologie.

Preventive measures in occupational dermatology have proven to be very effective in recent years, especially measures of primary and secondary prevention as components of a complex hierarchical prevention concept. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed ("tertiary individual prevention" [TIP]). TIP comprises 3 weeks inpatient treatment including intensive disease-oriented teaching and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study ("Medizinisch-Berufliches Rehabilitationsverfahren Haut--Optimierung und Qualitätssicherung des Heilverfahrens" [ROQ]) started which will further standardize TIP and evaluate long-term success and scientific sustainability in depth. This integrated concept of an inpatient/outpatient disease management reveals remarkable pertinent options for patients with severe occupational dermatoses in all high-risk professions.

[Optimal care of patients with occupational hand dermatitis: considerations of German occupational health insurance]. / Optimierte Versorgung von Patienten mit berufsbedingten Handekzemen: Hautarztverfahren und Stufenverfahren Haut der gesetzlichen Unfallversicherung.

Occupational dermatoses (OD) have been at the top of all occupational diseases in Germany for years (>25% of all occupational diseases officially reported annually to the public statutory employers' liability insurance bodies). More than 90% of OD-cases are hand eczema. Several pilot initiatives to improve prevention of occupational skin diseases have been developed and funded since 2005 by the statutory employers' liability insurance schemes. The concept underpinning these initiatives is a nationwide multi-step intervention approach recently implemented by the public statutory insurance system administration ("step- wise procedure") which aims at offering quick and specific preventive help at all levels of severity of OD. The dermatologist has a pivotal function in this concept; for early secondary prevention, the so-called dermatologist's procedure was recently updated in order to provide more rapid and concise dermatological consultations and care. Additionally, combined outpatient dermatological and educational intervention seminars ("secondary individual prevention", SIP) and interdisciplinary inpatient prevention measures have been developed ("tertiary individual prevention", [TIP]) and are currently being further evaluated in multicenter studies.

Ethylene oxide as an occupational contact allergen - an underestimated problem?

BACKGROUND: Ethylene oxide (EtO) is a volatile epoxy compound which is used to sterilize medical devices. EtO may cause irritant contact dermatitis, but only few cases of allergic contact dermatitis have been reported yet. OBJECTIVES: About 20 employees of a department for surgery developed eczematous skin reactions at the contact areas to wrist bands of surgical gowns which had been sterilized with EtO. Patch tests were performed to exclude contact allergy. METHODS: Due to the volatility of EtO, patch tests were done with epichlorohydrin (0.1% pet., 1% pet.) which is an epoxy compound chemically related to EtO. RESULTS: 7/8 patients and 4 healthy control persons showed non-allergic irritant reactions to 1.0% epichlorohydrin. 1.0% epichlorohydrin may have induced an iatrogenic sensitization in one of the control persons. None of the control persons reacted to 0.1% epichlorohydrin. Allergic contact dermatitis to EtO and a cross sensitization to epichlorohydrin was diagnosed in a nurse who showed an allergic crescendo patch test reaction to 0.1% epichlorohydrin. CONCLUSIONS: EtO can act as an occupational contact allergen in health personnel, a problem that may have been underestimated in the past due to methodological difficulties in patch testing. When allergic contact dermatitis to EtO is suspected, a patch test to 0.1% epichlorohydrin should be performed.

Hyperresponsiveness to antihistamines in spontaneous urticaria and heat urticaria.

. BACKGROUND: H1 antihistamines are important drugs for the treatment of urticaria and are commonly well tolerated. Cases of hypersensitivity reactions to antihistamines have rarely been reported, the underlying pathomechanism is unknown yet. CASE REPORT: We report the case of a 28-year-old female patient suffering from chronic spontaneous urticaria who experienced severe episodes of wheals and flares induced by different H1 antihistamines. METHODS: We performed skin prick tests (SPT) with a diversity of H1 antihistamines and CAST and FlowCAST analyses. Moreover, a placebo controlled oral challenge test to mizolastin was done. RESULTS: We saw positive SPT reactions to nearly all H1 antihistamines tested with the exception of mizolastin. We observed neither a release of sulfidoleukotrienes nor an upregulation of basophil activation markers in the CAST and FlowCAST analyses. The oral challenge test with mizolastine resulted in the development of generalized wheals and flares. CONCLUSION: H1 antihistamines are effective drugs for the treatment of urticaria, but they may lead to hypersensitivity reactions in rare cases. Because of the negative CAST and FlowCAST results, an IgE-mediated pathomechanism is improbable. We propose that hypersensitivity reactions to H1 antihistamines may be induced by a paradox H1 receptor activation.

Non-Hodgkin's lymphoma after primary Hodgkin's disease in the German Hodgkin's Lymphoma Study Group: incidence, treatment, and prognosis.

PURPOSE: The cumulative incidence for non-Hodgkin lymphoma's (NHL) after primary Hodgkin's disease (HD) ranges between 1% and 6%. To investigate the course of disease for secondary NHL, we retrospectively analyzed patients treated within clinical trials of the German Hodgkin's Lymphoma Study Group (GHSG) since 1981. PATIENTS AND METHODS: From 1981 to 1998, the GHSG conducted three generations of clinical trials for the treatment of primary HD involving a total of 5,406 patients. Reference histology by an expert panel was obtained for 4,104 of the patients. Data on incidence, treatment, and outcome of secondary NHL were updated in March 1999. RESULTS: At first diagnosis of HD, the pathologists rejected 114 (2.1%) of 5,520 cases initially diagnosed as HD and rediagnosed them as primary NHL. Fifty-two (0.9%) of the remaining 5,406 patients developed a secondary NHL. One patient was excluded from further analyses because of insufficient documentation. Six patients had no further therapy because of patient refusal (n = 1) or rapidly progressive disease (n = 5). For the remaining 45 patients, overall response rate was 43% (36% complete response and 7% partial response). The actuarial 2-year freedom from treatment failure (FFTF) and overall survival (OS) for all patients was 24% and 30%, respectively, and for patients with diffuse large-cell lymphoma, it was 28% and 35%, respectively. Time of occurrence of secondary NHL after first diagnosis of HD and variables employed in the age-adjusted International Prognostic Factor Index (IPFI) significantly influenced treatment outcome. CONCLUSION: In the GHSG, the incidence of secondary NHL with 0.9% is relatively low compared with previously reported series. The prognosis of secondary NHL seems dismal and is significantly influenced by time of occurrence and the age-adjusted IPFI. In a subset of patients with secondary NHL, long-term disease-free survival could be achieved.

Heavy metal accumulation (lead and cadmium) and ion exchange in three species of Sphagnaceae : I. Main principles of heavy metal accumulation in Sphagnaceae.

Three different species of Sphagnum mosses originating from a bog ("Hochmoor") were examined with respect to their behaviour of accumulation of heavy metal ions lead and cadmium. A strong bond of double charged Pb could be found independent of the Sphagnum species. When competitive reactions were performed in test solutions, with two ions (Pb2+ and one alkali or one earthalkali ion) or three (Pb2+ and one earthalkali and one alkali ion) Pb2+ was always accumulated too. This leads to a suppression of exchange of the other ions. Cadmium is by far less strongly bound than lead. Cadmium was tested in combination with two or three ions as was done for lead. The behaviour of cadmium adsorption is similar to that of calcium. For a number of ions typical tendencies were observed, which give insight in the quantity and strength of their binding to the exchanging material. The following series of accumulation was found: Pb2+>Cd2+≥Ca2+>Mg2+>K+>Na+≥NH inf4sup+ . (Accumulation was determined in test solutions containing each ion in the concentration 0.01N.) Differences in this series selectivity could not be found within the three Sphagnum species. But there exist typical differences in the total amount of adsorbed ions per unit dry weight. This species specific value corresponds with total capacities for ion exchange of the three species. Furthermore acid strength as well as pH-dependence of the ion exchanging Sphagnum material were investigated. Its physico-chemical behaviour may be described as that of a weak acid polyelectrolyte with variable charge, depending on ionic strength.

Heavy metal accumulation (lead and cadmium) and ion exchange in three species of Sphagnaceae : II. Chemical equilibrium of ion exchange and the selectivity of single ions.

Chemical equilibrium of ion exchange reactions of Sphagnum mosses was investigated for four different combinations of ions. These combinations were: Pb/Ca; Cd/Ca; Pb/K; Cd/K. Based on the law of mass action one can find mathematical descriptions of ion exchange reactions which permit one to calculate a state of equilibrium. As a measure of ion selectivity a rational coefficient of selectivity can be used. For culture experiments three different species of Sphagnum originating from a bog ("Hochmoor") in southern Bavaria were used. With these species coefficients of selectivity of the mentioned heavy metals were determined in solutions of different total ion content. Furthermore for each test solution of fixed total concentration the portions of the ions were altered. The Sphagnum material shows the behaviour of a relative ideal ion exchanger, whose states of equilibrium can be well described by the mathematical equations. The coefficients of selectivity are independent of Sphagnum species. In all cases they reflect the preferred binding of lead to the exchanger. Cadmium and calcium are adsorbed in approximately equivalent amounts. Representative limit isotherms permit an estimation of the errors caused by variation of the rational coefficients of selectivity. The applicability of the determined interactions and regularities on heavy metal monitoring programs is discussed.

A comparison of body fat estimates using anthropometry and bioelectrical impedance analysis with distinct prediction equations in elderly persons in the Republic of Guatemala.

Bioelectrical impedance analysis (BIA) has been proposed as a technique to estimate body composition. Its application has extended beyond the clinical setting, however, it remains to be determined if the BIA prediction formulas published to date provide comparable body composition estimates in elderly populations. The objective of this study was to compare the estimates of body fat derived from published prediction equations in a developing country's population such as Guatemala. A total of 234 elderly persons were studied (108 males and 126 females), with ages of 78 +/- 7 and 77 +/- 8 (mean +/- SD) yr, respectively. The height and weight averaged 156.4 +/- 7.9 and 144.0 +/- 7.0 cm, and 54.5 +/- 9.4 and 49.4 +/- 10.6 kg, for males and females, respectively. Measurements included skinfolds (triceps, biceps, subscapular, and suprailiac), and body resistance (BIA). Body fat estimates were derived from four BIA-prediction formulas and three equations based on anthropometry. Mean percent body fat estimates for the overall population obtained from anthropometry and BIA prediction formulas ranged from 22 to 50%. Females had higher estimates compared to males without regard for the method used. Highly significant intermethod correlations were seen, but differences in fat estimation among prediction formulas were noticed and the magnitude of the differences were BIA-formula dependent.

Behavioural response to humans and the productivity of commercial dairy cows.

This study examined the relationships between the attitude and the behaviour of the stockperson towards cows and the behavioural response to humans and the milk production of cows at 31 commercial dairy farms over one lactation. The attitude of the stockperson was measured on the basis of the stockperson's opinion of the cow's behaviour and how the stockperson evaluated his own behaviour. The behaviour of the stockperson was measured by recording the nature and frequency of the tactile interactions and some visual and auditory interactions directed towards the cows. The behavioural response of cows to humans was assessed by observing their approach behaviour to an unfamiliar experimenter in a standard test and production records were collected for the entire lactation at each farm. Correlation and regression analyses using farm averages were used to examine relationships between human and cow variables. Several cow behaviour variables, indicative of fear of humans, were moderately (P<0.05) to highly (P<0.01) correlated with milk yield and composition and regression analysis indicated that fear of humans accounted for 19% of the variation in milk yield between farms. The results suggest that at farms where milk yield was low, cows showed less approach to the experimenter in the standard fear test than at farms where milk yield was higher. A composite attitude score, based on the responses of stockpeople to questions about patting and talking to cows, ease of movement of cows and cows recognising unfamiliar stockpeople, was moderately (P<0.05) to highly (P<0.01) correlated with the behaviour of the stockperson. While a number of stockperson behaviour variables were correlated (P<0.05) with milk yield, the former variables were generally poorly correlated with cow behaviour. Therefore these preliminary findings provide evidence that, as seen in the pig industry, sequential relationships may exist between the attitude and behaviour of the stockperson and the behaviour and productivity of commercial dairy cows. Research is required to further examine these relationships because of the possible implications on cow productivity and welfare.

Screening of chemical oxidation processes and other methods for decolorization of urine for its re-use as toilet-flush liquid in ecological sanitation systems.

Because of its potential use as fertilizer, urine ("yellow water") is a resource originating from sanitation. Its separate collection in no-mix toilets is a beneficial aspect of ecological (source control) sanitation. In order to avoid dilution of the fertilizing nutrients with toilet flush water, the utilization of yellow water as toilet flush liquid seems to be advantageous. To be accepted for this purpose, urine has to be decolorized (and also deodorized). In this study activated carbon adsorption, irradiation with UV light of different wavelengths, the advanced oxidation processes ultrasound, UV/H2O2, and photocatalytic oxidation have failed to decolorize urine. Biological treatment caused brown colour of the treated urine. Only ozonation was successful in colour removal, although it did not affect TOC. In spite of darkening of yellow water during biological treatment (generation of humic substances), smaller ozone doses were required for decolorizing the biologically pre-treated urine than for original urine. Photocatalytic oxidation of biologically treated urine also removed brown colour, but the original yellow colour remained. In ozonated urine, yellow colour was reconstituted unless hydrogen peroxide was added. In addition to colour removal, ozone contributed to deodorization as a consequence of ammonia stripping and probably of phenol oxidation.

[Long-term toxic sequelae of the treatment of Hodgkin's disease]. / Langzeittoxizitäten in der Behandlung des Morbus Hodgkin.

In recent years, continuous optimization of therapy has decisively improved the prognosis of Hodgkin's disease. However, this improvement in overall survival has also led to an increase in several possible late effects which the clinician must be aware of. Due to the appearance of chronic fatigue symptoms, cardiopulmonary problems, hypothyreosis and damage to the gonadal system including azoospermia and ovarian insufficiency, the mostly young patients often suffer a persistent reduction in quality of life. In addition, the increased incidence of second malignancies following successful primary treatment presents a considerable problem. While complete remission and prolonged survival were previously the main objectives in the therapy of malignant lymphomas, reduction or avoidance of toxicity is now becoming more and more central. This development has led to the increasing importance of late sequelae and quality of life as endpoints in modern therapy trials in oncology.

[Relationship between plasmatic lipids and fat soluble vitamins in Guatemalan periurban elderly]. / Relación entre lípidos plasmáticos y vitaminas liposolubles en anciano peri-urbanos de Guatemala.

The levels of plasmatic lipids and fat liposoluble vitamins were measured in 107 elderlies (29% males, 71% females) who were residents of a poor periurban neighborhood of Guatemala City. The age ranged between 60-103 years (means +/- sd 69 +/- 8). The mean and sd for the plasmatic levels of lipids and vitamins were (ranges in parenthesis): cholesterol 220 +/- 42 mg/dl (128 to 428); triglycerides: 189 +/- 92 mg/dl (54 to 513); retinol 50 +/- 16 ug/dl (4.5 to 103); beta-carotene 17 +/- 12 ug/dl (12 to 60), tocopherol 1.32 +/- 0.36 mg/dl (0.54 to 2.46). A significant correlation was found in both sexes between cholesterol and retinol (r = 0.3, p < 0.05) and cholesterol and tocopherol (r = 0.4, p < 0.05), triglycerides and retinol (r = 0.3, p < 0.05). Cholesterol and beta-carotene was also significant in women (r = 0.5, p < 0.05). The correlation between triglycerides and beta-carotene by gender was not significant.