Theo Rufli

Oral hairy leukoplakia in a HIV-negative renal transplant patient: a marker for immunosuppression?

We report the case of a 58-year-old renal transplant patient who developed oral hairy leukoplakia. Examination for HIV-1 and HIV-2 infection was negative. Biopsy of the lateral tongue showed ballooned prickle cells and electron microscopy revealed herpes-type viruses. In situ hybridization and examinations with the Southern blot technique yielded Epstein-Barr virus. Serology for Epstein-Barr virus was reactive. Immunological investigation of the patient showed a marked decrease of T-helper and T-suppressor cells as the result of immunosuppressive regimen. Oral hairy leukoplakia may be a marker for severe immunosuppression but is not necessarily associated with HIV infection.

Atrophoderma of Pasini and Pierini: Clinical and histopathologic findings and antibodies to Borrelia burgdorferi in thirty-four patients

BACKGROUND Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a distinctive form of dermal atrophy, usually appearing as one or more sharply demarcated depressed areas. Little is known about the clinical variants of IAPP, and limited data are available on antibiotic therapy for this condition. OBJECTIVE Our purpose was to define the various types of IAPP clinically and histologically and to investigate a possible association with Borrelia burgdorferi infection. METHODS The records of 34 patients with IAPP were reviewed. Skin biopsy specimens for routine histologic examination were obtained from 17 patients. Serum from 26 patients was analyzed for antibodies against B. burgdorferi. RESULTS Of the 34 patients (21 female, 13 male, 7 to 66 years of age), 23 had well-circumscribed brown, depressed plaques. The back was most frequently involved (82%). Eleven patients had a superficial variant of IAPP, characterized by slightly atrophic brown macules forming large hyperpigmented patches with an irregular border. Secondary areas of induration developed in 7 of 34 patients. Ten of 26 patients (38%) had elevated serum antibodies to B. burgdorferi. Twenty of the 25 patients treated with oral antibiotics had clinical improvement with no evidence of new active lesions. CONCLUSION IAPP is an abortive, primarily atrophic variant of morphea. The clinical appearance of IAPP may be variable according to the stage of dermal atrophy and distribution of the lesions.

SPECIFIC STIMULATION OF MIGRATION OF HUMAN KERATINOCYTES BY μ -OPIATE RECEPTOR AGONISTS

ABSTRACT There are several indications that neuropeptides, especially the opiate receptor agonists, modulate the immune response by stimulating the formation of granulation tissue and enhancing the reepithelialization. We observed that the μ-opiate receptor ligand β-endorphin stimulates the migration of cultured human foreskin keratinocytes. After 1 hour exposure to 1 µM β-endorphin, the keratinocytes experienced an increase of cell diameter by cellular elongation and stimulation of migration. Dynorphin had a lesser effect under the same condition. The opiate receptor antagonist naltrexone significantly reduced the effect of β-endorphin on keratinocyte migration. This migratory effect of μ-opiate receptor agonists in vitro indicates that the opioid peptides, released in wounds, could play a key role in the final reepithelialization and tissue regeneration in wound healing. This new knowledge will help us not only to understand the mechanism of wound healing but also to improve the therapeutic strategy in the healing of painful chronic wounds.

Localized scleroderma associated with Borrelia burgdorferi infection: Clinical, histologic, and immunohistochemical observations

BACKGROUND Recent reports have implicated Borrelia burgdorferi infection as a possible cause of localized scleroderma (LS). OBJECTIVE Our purpose was to describe the clinical, histologic, and immunopathologic features of patients with LS who had serum antibodies to B. burgdorferi. METHODS Ten patients were examined clinically and by routine microscopy. Biopsy specimens from seven patients were studied immunohistochemically with monoclonal antibodies. The proliferative response of peripheral blood mononuclear cells to B. burgdorferi was investigated in seven patients by lymphocyte proliferation assay. RESULTS Seven patients had plaque-type morphea, and three patients had linear scleroderma. Two patients had a history of previous erythema migrans. One patient had coexistent acrodermatitis chronica atrophicans, and in two patients lichen sclerosus et atrophicus was observed. Histologically, a prominent inflammatory phase with sclerosis of the connective tissue was shown in all patients. Immunohistochemical studies revealed that the inflammatory infiltrates consisted of both B and T lymphocytes, predominantly of the CD4+ subset. All 10 patients had strongly elevated serum antibodies to B. burgdorferi. Patients with LS showed significantly elevated lymphoproliferative responses to B. burgdorferi when compared with healthy control subjects. CONCLUSION Our findings suggest that some cases of LS are linked to Borrelia infection.

Oral manifestations in HIV-infected patients: diagnosis and management.

Oral lesions have been observed since the beginning of the AIDS epidemic. The number of HIV-infected patients is still increasing, especially in the heterosexual population. Oral diseases in HIV-infected patients are often more difficult to diagnose because the clinical presentations may differ from the same diseases in HIV-negative patients. HIV-associated oral lesions have diagnostic, prognostic, and therapeutic impact. Approximately 10% of the HIV-infected population will have oral manifestations as a first sign of their disease. In HIV-infected men oral hairy leukoplakia and oral candidiasis are useful markers for disease progression. This article summarizes the oral manifestations and the management of oral health in persons with HIV infection.

Formationsmuster des Hautepithels bei Mensch und Meerschweinchen

Comparative histometry of human and guinea-pig epidermis revealed that in the latter development of the (subcorneal) superficial epithelium is significantly less, and that of the (mostly follicular) d

Pyoderma malignum – ungewöhnliche Spielform des Pyoderma gangraenosum

We report the 15th case of malignant pyoderma. In agreement with other authors we consider this disease as a special form of pyoderma gangrenosum. Therapy with isotretinoin 40 mg daily showed a marked improvement in our patient.

Antibiotic Sensitivity of Gonococcal Strains Isolated from Patients in Basel and Environs

During the first 4 months of 1977, 95 different strains of gonococcus were isolated in the out-patient department of the Dermatology Clinic of the University of Basel. These were systemically tested for sensitivity to penicillin G, spectinomycin, thiamphenicol, doxycycline and rifampicin. The MIC values and the diameter of the zones of inhibition were determined. Tests for beta-lactamase production were made. A correlation in the degree of sensitivity was observed between the following antibiotics: penicillin G/rifampicin; penicillin G/thiamphenicol; penicillin G/doxycycline; thiamphenicol/doxycycline; thiamphenicol/rifampicin; doxycycline/rifampicin. The size of the inoculum had little influence on the activity of the substances, except for that of penicillin G against the beta-lactamase-positive reference strains. No beta-lactamase-producing strains were detected amongst the clinical isolates. In the case of penicillin G, there was a correlation between the minimum inhibitory concentration and the inhibition-zone diameter.