Speelveld en strijdtoneel

REDE uitgesproken bij de openbare aanvaarding van het ambt van gewoon hoogleraar in de dermatologie en venerologie aan de faculteit der geneeskunde aan de Erasmus Universiteit Rotterdam op woensdag 25 mei 198

Cutaneous pathology in primary erythermalgia

Primary or idiopathic erythermalgia is characterized by recurrent, red, warm, and painful lower extremities. It arises at young age and persists throughout life because no treatment is available. We report the cutaneous pathology of affected skin lesions of three patients with primary erythermalgia. Biopsy specimens showed a mild perivascular mononuclear infiltrate, thickened blood vessel basement membranes, abundant perivascular edema, and moderate endothelial swelling. The thickened basal membrane of the blood vessels showed a laminar structure, and abundant perivascular edema and moderate endothelial cell swelling were evident. These histopathologic findings in primary erythermalgia appear to be nonspecific but allow diagnostic differentiation from erythromelalgia in which fibromuscular intimal proliferation and occlusive thrombi in the endarteriolar capillaries are apparent and from erythermalgia secondary to vasculitis. Histopathologic examination of affected skin lesions in patients with red, congested, warm, and painful burning extremities is a valuable tool in the diagnostic process

Cyclosporin in atopic dermatitis: A multicentre placebo-controlled study

The efficacy of cyclosporin (Sandimmun®) given in a daily dose of 5 mg/kg for 6 weeks in severe atopic dermatitis was confirmed in this double-blind, placebo-controlled, short-term study. Of the 46 patients included in the study, 23 were randomized to receive cyclosporin and 23 to receive placebo. Four of the 23 patients (17%) on cyclosporin, and 14 of the 23 patients (61%) who received placebo, discontinued the trial because of inefficacy. All patients who discontinued the trial were assessed following the principle the principle of ‘intention to treat’. Compared with the baseline, the mean scores for disease severity [6-area, total body severity assessment (TBSA)] improved by 55%, and the mean scores for extent of disease [rule-of-nines area assessment (RoNAA)] improved by 40%, in patients treated with cyclosporin. Nine of the patients who received cyclosporin and completed the study (n=14) had an individual reduction of disease severity (TBSA) of 75% or more, and in three patients this reduction was nearly 100%. In the placebo group, a mean worsening of disease severity (4%) and of extent of the disease (25%), compared with the baseline, was observed al week 6. Patients' and investigators' mean scores for the overall efficacy were similar, and showed a statistically significant difference in favour of cyclosporin. Two patients on cyclosporin developed hypertension during therapy, and one of these withdrew from the study. At the end of the trial, no statistically significant differences in the systolic or diastolic blood pressures were observed between the two groups. In the cyclosporin group, the increases in the values of serum creatinine and bilirubin at week 6, compared with the respective values at the baseline, were statistically significantly different from those in the placebo group, but all values normalized in the post-treatment period. Cyclosporin can be a safe and very effective treatment in episodes of severe atopic dermatitis, provided that the recommended guidelines for its administration are strictly observed

Sequence and evolution of the regions between the rrn operons in the chloroplast genome of Euglena gracilis bacillaris

The rRNA genes are arranged in three sequential operons preceded by a fourth partial operon. Part or all of a 1462 nucleotide sequence extending from within the 3′-end of the 23S rRNA gene, across the 5S rRNA gene and a presumptive transcription terminator, to within the first structural gene (for 16S rRNA) of the rrn operon was determined for each region between operons. Homologies of the 3′-end of the 23S rRNA gene with the 4.5S rRNA genes of higher plant chloroplasts, and of the 5S rRNA gene with other 5S rRNA genes were examined. The region preceding the 16S rRNA gene, which is expected to contain sites for initiation and regulation of rrn transcription, includes a 305 base-pair sequence with substantial homology with structural genes elsewhere in the chloroplast genome. The homologies suggest that this portion of the leader evolved from copies of parts of the structural genes which had been inserted before the 16S rRNA genes. Thus the chloroplast rrn leader may provide a unique opportunity to study how a regulatory sequence evolved from well-defined structural genes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47554/1/438_2004_Article_BF00425555.pd

Somatostatin receptor scintigraphy in cutaneous malignant lymphomas

Background: Lymphoid cells may express somatostatin receptors (SS-Rs) on their cell surface. Therefore radiolabeled somatostalin analogues may be used to visualize SS-R-positive lymphoid neoplasms in vivo. Exact staging is the basis for treatment decisions in cutaneous malignant lymphoma. We considered the possibility that SS-R scintigraphy might offer a clinically useful method of diagnostic imaging in patients with cutaneous malignant lymphoma. Objective: We evaluated SS-R scintigraphy in comparison with conventional staging methods in the staging of cutaneous malignant lymphoma. Methods: We conducted a prospective study in 14 consecutive patients with histologically proven cutaneous malignant lymphoma. SS-R scintigraphy was compared with physical, radiologic, and bone marrow examinations. Lymph node excisions were performed in patients with palpable lymph nodes. Results: SS-R scintigraphy was positive in the lymph nodes in all four patients with malignant lymph node infiltration and negative in the three patients with dermatopathic lymphadenopathy. In two patients, previously unsuspected lymphoma localizations were visualized by SS-R scintigraphy. In only three patients all skin lesions were visualized by SS-R scintigraphy; these three patients had not been treated with topical corticosteroids. SS-R scintigraphy failed to detect an adrenal mass in one patient and bone marrow infiltration in two patients. Conclusion: SS-R scintigraphy may help distinguish dermatopathic lymphadenopathy from malignant lymph node infiltration in patients with cutaneous malignant lymphoma