[A pseudo-outbreak of pharyngeal gonorrhoea related to a false-positive PCR-result]. / Een pseudo-uitbraak van keelgonorroe samenhangend met een fout-positieve PCR-uitslag.

Nucleic acid amplification tests, including the polymerase chain reaction (PCR), are sensitive and specific tests that are often used for diagnosing sexually transmitted diseases (STDs). A pseudo-outbreak of pharyngeal gonorrhoea in a group of prostitutes turned out to have been caused by false-positive test results due to commensal oropharyngeal Neisseria species. Specific molecular tests may yield erroneous results. When the results of an STD study have major consequences at a legal or social level, it is advisable, in consultation with a medical microbiologist, to take a sample for culture or to carry out a second molecular test aimed at a different part of the bacterial genome.

[Penis friction edema: not a venereal disease]. / Penisfrictie-oedeem: geen seksueel overdraagbare aandoening.

A 35-year-old man presented with a local swelling of the penis, which increased until the entire penis was thick and swollen. After infectious and obstructive causes had been eliminated, a diagnosis of 'penis friction oedema' was made. The swelling disappeared during several weeks of abstinence from sexual intercourse. Penile abnormalities can be divided into venereal diseases (STDs), incidental affections of the skin or mucous membranes in that location, and disorders of vascularisation and lymph drainage. A traumatic disorder of lymph drainage is sometimes referred to, unjustifiably, as 'penile venereal oedema'; it is a result of friction and manifests itself as local or total penile oedema or as a cordlike congestion of the lymphatic vessels. The diagnosis is by exclusion and the treatment is temporary abstinence from sexual intercourse.

[Diagnostic image (102). A man with an itching foot. Larva migrans cutanea]. / Diagnose in beeld (102). Een man met jeuk aan de voet. Larva migrans cutanea.

A 27-year-old man presented with larva migrans cutanea on his left foot after a journey to the Philippines.

[A new option for skin rejuvenation: CO2-laser resurfacing]. / Een nieuwe mogelijkheid om huid te verjongen: CO2-laser-'resurfacing'.

Resurfacing denotes mechanical, chemical or physical removal of the superficial layers of aging skin, after which collagenesis is reactivated with improved epidermal architecture as a result. CO2 laser resurfacing is a modern technique for the treatment of skin aging. With CO2 laser resurfacing it is possible to perform accurate ablation of layers of the skin. Besides the cosmetic indications, this technique is a good treatment modality for a broad spectrum of dermatological diseases.

[Effective treatment of recurrent keratoacanthoma using methotrexate]. / Effectieve behandeling van recidiverend kerato-acanthoom met methotrexaat.

Three patients, two men aged 54 and 72 years, respectively, and a woman aged 52 years, were treated successfully for (recurrence of a) keratoacanthoma with methotrexate. Since the sixties 11 patients with recurrent keratoacanthoma treated with methotrexate have been described. Dose schedules were widely different and dosages were in general high, resulting in more or less severe side effects. The patients now presented were treated according to the Weinstein schedule, with small doses and during a short period, which minimises the adverse effects.

[The treatment of basal cell carcinoma patients by dermatologists in Netherland]. / De behandeling van patiënten met basalecelcarcinomen door dermatologen in Nederland.

OBJECTIVE: To determine the policy of dermatologists practising in the Netherlands in the treatment of basal cell carcinoma. DESIGN: Written enquiry. SETTING: Catharina Hospital, Eindhoven, the Netherlands. METHOD: All 293 dermatologists practising in the Netherlands were sent a questionnaire in May 1996 containing 15 questions about diagnosis and treatment of basal cell carcinoma. RESULTS: Eighteen forms dropped off because of termination of the practice or joint completion in group practices. The response was 76% (208/275). The diagnosis was made usually on the basis of histological examination (71% of the respondents; 84% in a tumour recurrence). Excision was the preferred treatment for all subtypes of basal cell carcinoma; second choices were cryosurgery or curettage/electrocoagulation. Roentgen contact therapy has been practically abandoned. New methods such as photodynamic therapy and immunotherapy are being used only sporadically on an experimental basis. Most dermatologists regarded tumour recurrences as a bigger problem than primary tumours. They attempt to reduce the percentage of recurrences by giving advice about risk factors (sunlight). CONCLUSION: Too little use is being made of diagnostic biopsy to enable an optimal choice of therapy of basal cell carcinomas, especially in cases of recurrence tumours.

[Immunoglobulin deposits in vascular walls in cutaneous lupus erythematosus. Immunofluorescence study]. / Dépots d'immunoglobulines au niveau des parois vasculaires au cours du lupus érythémateux cutané. Une étude en immunofluorescence.

This paper reports an immunofluorescence (IF) study of the skin of 16 patients with chronic discoid localised lupus erythematosus and 5 patients with cutaneous disseminated lupus erythematosus. In the majority of the cases (18), we have found immunoglobulin and complement deposits not only along the dermoepidermal junction, but also in the blood vessel walls. In these deposits there was a predominance of IgM. It appears that an immune complex vasculitis in the skin can be found in patients from the entire lupus erythematosus spectrum. The discovery of immunoglobulins and complement deposits in the blood vessel walls of the involved skin of patients with discoid lupus erythematosus, suggests that it can be considered as an important (and even characteristic) feature of the disease.

Evaluation of conventional and real-time PCR assays using two targets for confirmation of results of the COBAS AMPLICOR Chlamydia trachomatis/Neisseria gonorrhoeae test for detection of Neisseria gonorrhoeae in clinical samples.

Two conventional PCR-enzyme immunoassays (PCR-EIAs) and two real-time PCR assays (LightCycler system; Roche Diagnostics) were evaluated as confirmation assays with cppB and 16S rRNA genes as targets. Of 765 male and female genitourinary and nasopharyngeal specimens positive for Neisseria gonorrhoeae in the COBAS AMPLICOR Chlamydia trachomatis/Neisseria gonorrhoeae PCR test (Roche Diagnostics), 229 (30%) were confirmed positive; 13 of these (5.7%) were lacking the cppB gene. Of the 534 samples (70%) that could not be confirmed, 81 (15%) showed a positive crossing point. However, melting curve analysis revealed an aberrant melting temperature in the LightCycler 16S rRNA assay; therefore, these samples were considered non-N. gonorrhoeae Neisseria species. Both of the 16S rRNA assays performed well, with positive predictive values of 99.1% and 100% for the PCR-EIAs and the real-time assays, respectively, and a negative predictive value of 99.8% for both. The cppB assays were compromised by the absence of the cppB gene in 5.7% of the N. gonorrhoeae-positive samples, resulting in negative predictive values of 96.8% and 97.6% for the PCR-EIAs and the real-time assays, respectively. Therefore, the 16S rRNA gene is preferable to the cppB gene as a target for confirmation assays. The melting curve analysis of the real-time assays provides useful additional information.

Immunofluorescence studies on eosinophilic granulocytes.

Immunofluorescence techniques were used to find out whether immunoglobulins (Ig) and complement (C3) determinants are present on the membrane of eosinophilic granulocytes in atopic patients and in patients with an allergic contact dermatitis. Normal healthy individuals served as controls. The studies were performed with eosinophilic granulocytes in suspension and in thin cell layers. The demonstration of the presence of cytoplasmic Ig and C3 in eosinophilic granulocytes was carried out in skin specimens taken 20-30 min after injection of the antigen and in specimens taken from positive patch tests 48 h after application of the antigen. No immunoglobulins or C3 determinants could be demonstrated on the membrane of eosinophilic granulocytes in the patients or the healthy controls, when the suspension methods were used. However, in thin cell layers and in skin sections the eosinophilic granulocytes showed a positive fluorescence of the cytoplasm after having been exposed to various conjugates and a FITC solution. It is concluded that the commonly used immunofluorescence techniques tend to give non-specific staining results, most likely due to reactivity of the FITC marker of the conjugates with basic proteins present in the cytoplasm of the eosinophilic granulocyte.

The aniline blue fluorescence staining of eosinophilic granulocytes.

An aniline blue fluorescence staining technique specific for eosinophils was compared to haematoxylin and eosin to determine the percentages of eosinophils in the peripheral blood of patients with atopic or with allergic contact dermatitis. The aniline blue technique proved to be excellent for demonstrating eosinophilic granulocytes. Although the eosinophilic granulocytes were reasonably demonstrable in thin layers stained with haematoxylin and eosin, the aniline blue staining seems to be better in cases of doubt. Using the same techniques the presence of eosinophil granulocytes was studied in 5 punch biopsies taken from positive patch tests (after 48 h) and 5 biopsies from positive skin reactions after and intradermal injection with an atopic allergen (after 20--30 min). In all punch biopsies taken after an intradermal injection with an atopic allergen, eosinophilic granulocytes, often numerous, were seen in the vessels of the dermis. In punch biopsies taken from positive patch tests the eosinophilic granulocytes were seen scattered through the dermis in variable numbers.

Eosinophilic granulocytes and skin disorders.

The eosinophilic granulocytes remain intriguing cells. At the moment there are several skin disorders such as incontinentia pigmenti (Siemens-Bloch), pustulosis of the newborn, etc, in which the presence of eosinophils has not yet been studied. Basic aspects of the function of the eosinophils and their relationship with other inflammatory cells are being eliminated gradually. In the near future it will become clearer why, in certain circumstances, eosinophils are necessary or undesirable. These new data will be of great significance for clinical dermatology and skin pathology. In what circumstances do the eosinophils modulate inflammatory reactions and when do the cytotoxic capacities come to the fore? Other chemotactic factors will be detected, especially those related to the local inflammatory cells, lymphocytes, macrophages, and polymorphonuclear leukocytes. With the aid of these findings it will be possible to understand better why eosinophilic granulocytes are present in different skin disorders. Finally, regulation and influence of their behavior may become a possibility.

Granulomatous secondary syphilis coinciding with PUVA treatment in a patient with psoriasis: an apparent failure of PUVA therapy.

A 39-year-old man is described who has been suffering from psoriasis for many years. Because of the extensive involvement of the skin he was treated with PUVA therapy, initially with a good result. A second course of PUVA treatment was unsuccessful. Histopathological examination of the (persisting) skin lesions at this time showed clear granulomatous infiltration, in addition to psoriatic changes. Based on history, serological and dark-field examination, a secondary syphilis was diagnosed. The possible influence of PUVA therapy is discussed.

Treatment of ulcers on legs from venous hypertension by split-thickness skin grafts.

Chronic ulcers on legs resulting from venous hypertension can be successfully managed by split-thickness skin grafts. Special attention must be paid to preliminary preparation of ulcers and to the period after grafting. Technical details of grafting are described and the results in 12 patients are recounted.

Hepatitis B surface antigen deposition in the blood vessel walls of urticarial lesions in acute hepatitis B.

Urticaria is known to occur in the pre-icteric phase of acute viral hepatitis. Often such urticaria is a symptom of a serum sickness-like syndrome which can be a prodrome of viral hepatis. Immune complexes are thought to be pathogenetic in this condition. In this paper we present two patients with a serum sickness-like syndrome, urticaria and hepatitis B. By immunofluorescence techniques Hepatitis B surface antigen, CIq and C3 could be demonstrated in the blood vessels of the superficial dermis. These findings are consistent with the immune complex hypothesis.