[Metastatic malignant melanoma in treated non-Hodgkin's lymphoma]. / Metastasiertes malignes Melanom bei therapiertem Non-Hodgkin-Lymphom.

Secondary cutaneous neoplasia, e.g. basal cell malignant carcinomas or squamous cell carcinomas, is frequently observed in patients with malignant lymphomas. The association between malignant lymphoma and secondary malignant melanoma has only been rarely reported. We describe a patient with a low-grade nodal B-cell lymphoma who, while on treatment with steroids and an alkylating agent, developed a malignant melanoma level IV which rapidly metastasized to lymph nodes involved by the malignant lymphoma.

Determination of dihydrocodeine in hair of opiate addicts by GC/MS.

After the examination of more than 300 hair samples of suspected heroin abusers, a large number of which proved positive, we can say that high concentrations of dihydrocodeine can be determined either in addition to, or in the place of, morphine and also frequently in combination with codeine. The opiates were extracted after dissolving the hair samples in NaOH and hydrolysis with HCl. The quantitative determination of dihydrocodeine was achieved by derivatisation with HFBA using GC/MS at m/u = 497. Dihydrocodeine is used in antitussive drugs. After the examination of individual hair samples, it was obvious that some heroin consumers had switched to dihydrocodeine. This may lead to the conclusion that dihydrocodeine itself is used either as an intoxicating drug or to reduce withdrawal symptoms. The increasing number of positive samples should be noted by the legal authorities.

Biological effects of shock waves: cavitation by shock waves in piglet liver.

Shock waves are known to generate cavitation in vitro. In vivo, extracorporeal shock waves may cause haemorrhages in tissues. Two types of changes were detected by conventional, real-time B-scan ultrasound when shock waves were administered to 5 piglet livers in vivo: transient changes consisting of bright signals in intrahepatic branches of the portal vein and tributaries of the hepatic vein, presumed to originate from gas bubbles, and stationary changes consisting of brightening of the area along the long axis of the high pressure field, presumed to indicate an increased number of gas-filled bubbles in this area. Transient changes appeared from the start of shock wave administration; bright signals were seen in liver vessels for several hundred microseconds before they were flushed away with the blood flow. Stationary changes appeared later, increased in intensity over several hundred shock waves and persisted for minutes after cessation of shock wave administration. Both types of signals were interpreted as direct evidence that lithotripter shock waves generated cavitation in vivo. Similar signals were received in the partly degassed water of the lithotripter tub. At autopsy of the piglets, focal intralobular haemorrhages and thrombi of portal veins were detected in the shock wave path. The occurrence of cavitation and tissue damage in the same gross area suggests that cavitation might be involved in the generation of tissue damage by shock waves.

Fragmentation of gallstones using extracorporeal shock waves: an in vitro study.

Eighty in vitro experiments were performed with single (n = 51) or multiple (n = 29) gallstones in order to find out which parameters are of prime importance for their disintegration by extracorporeal shock waves. A Dornier lithotripter and an upper limit of 1,500 discharges were employed. Although computed tomography density was significantly lower in cholesterol stones than in the noncholesterol stones (p less than 0.0001) and although the latter were significantly more often radiopaque (p less than 0.0001), we found no clear-cut correlation between the cholesterol content or computed tomography density and the degree of fragmentation of the stones. The most important variable which limited successful disintegration was the total stone volume. In stones with a mean total volume of 0.83 ml +/- 0.25 S.E. (diameter for single stones = 11.5 +/- 0.9 mm), none of the fragments exceeded 2 mm, whereas in stones with a mean volume of 3.6 ml +/- 0.64 (diameter = 17.2 +/- 1.5 mm) at least one fragment larger than 2 mm remained (p less than 0.002). Under the in vitro conditions, fragmentation was similar in multiple and solitary stones, provided the volume of the stones was comparable. These data show that, in general, the number and size of the stones, i.e. their total volume, and much less significantly their chemical composition are the major determinants of fragmentation by extracorporeal shock waves.

[Transmission sonographic diagnosis of infant hips]. / Transmissions-sonographische Diagnostik an der Säuglingshüfte.

By means of transmission sonography with incoherent ultrasound it is possible to obtain areal cross-section images of infants' hips which are free of interference and demonstrate axes accurately. It is possible to assess the condition of tendons, ligaments, capsular structures, and the bones, and their relative positions. The authors report on experience gathered since 1982 with the instrument developed at the Gesellschaft für Strahlen- und Umweltforschung (Society for Radiation and Environmental Research) in Munich. In addition to a brief description of the unit and an explanation of the examination technique, they discuss criteria of assessment and demonstrate on the basis of sample results that transmission sonographic findings can be assessed reliably in patients up to the age of 9 months. The possible significance of transmission sonography in the diagnosis and observation of congenital dislocation of the hip is discussed.

[Inclusion of clinical-dermatological therapy into general practice? (author's transl)]. / Ubernahme der klinisch-dermatologischen Therapie in die Praxis?

The ever increasing expenditures in health service urgently call for a critical revision of the therapy habitually practiced so far. This also includes the complete utilization of ambulatory therapeutic approaches. Moreover, after many years of clinical practice, the dermatologist in general practice should not forego the manifold therapeutic methods in which he had been trained and by the application of which he has gained particular experience. The dermatologist's small office consisting of a desk and couch must be a matter of the past once and for all. It is just the dermatologist who has the opportunity to try many forms of clinical treatment in general practice.

[Defective polymorphonuclear leukocyte function in chronic granulomatous muco-cutaneous candidiasis (author's transl)]. / Granulocytenfunktionsdefekte bei granulomatöser muco-cutaner Candidiasis

Chronic granulomatous muco-cutaneous candidiasis is reported in a 12-year-old boy who died of pulmonal cryptococcosis. Chemotactic and phagocytic functions of the neutrophilic polymorphonuclear leukocytes were deficient while the cell mediated immunity was not disturbed and no decrease of immunoglobulins and complement factors--especially C3 and C5--was found in the serum. The possibility is considered that the disturbance of lymphocyte mediated immune response is the normal, but not only fundamental aetiological factor of chronic muco-cutaneous candidiasis.

[Angiokeratoma corporis diffusum (Fabry's disease). Biochemical diagnosis in plasma]. / Angiokeratoma corporis diffusum (Morbus Fabry) Biochemische Diagnostik im Blutphasma

In a 35-year-old man with the full picture of Fabry's disease there was an almost fourfold increase of trihexosylceramide concentration in plasma and a decrease in the alpha-galactosidase activity to 13 percent as compared with the values from a control group. Using the same biochemical methods it could be shown that two nephews of the patient are hemizygote carriers and that two sisters and the mother of the patient are heterozygote carriers. Causative treatment of the disease is unknown. In this patient the attacks of pain could be permanently improved with phenytoin and carbamazepin.