[Tasks and function of the German Medical Review Board of the Statutory Health Insurance (MDK). Latest aspects in dermatology in view of social medicine]. / Aufgaben und Funktion des Medizinischen Dienstes der Krankenversicherung (MDK). Aktuelle Aspekte in der Dermatologie aus sozialmedizinischer Sicht.

The German Medical Review Board of the Statutory Health Insurance (MDK) is a sociomedical service for impartial medical opinion and consultation. Together with the statutory health insurance companies it takes part in shaping the public health care system. Many recent developments are changing the german health insurance system. This article illustrates the complex sociomedical framework of MDK's activities in relation to current issues in dermatology. The article focuses on: new diagnostic and therapeutic methods, drugs (off-label-use), out-patient and in-patient dermatological rehabilitation and hospital treatment.

Malignant proliferating trichilemmal cyst.

We report a case of a metastasizing proliferating trichilemmal cyst. A 78-year-old man had multiple common and two proliferating trichilemmal cysts, one of which showed malignant transformation as evidenced by lymph node metastases. Despite surgical removal of the malignant tumor, extensive metastatic disease rapidly occurred. This case exemplifies the difficulties in diagnosis and treatment of these rare tumors and their unpredictable course.

Recurrent papillomas of the nipple associated with human papillomavirus 41.

A case is described of a man with multiple papillomas on the nipple that resembled clinically and histologically condylomata acuminata. Human papillomavirus (HPV) type 41 DNA sequences were detected in the biopsy material. There was no evidence of any immunodeficiency.

Characterization of a new human papillomavirus (HPV 41) from disseminated warts and detection of its DNA in some skin carcinomas.

A new human papillomavirus type (HPV 41), distantly related to known HPV prototypes, was isolated from a patient with disseminated facial, peri-anal and foot warts (epidermodysplasia verruciformis was not diagnosed). The viral DNA was molecularly cloned in 2 BamH1 restriction fragments with sizes of 6.5 kb and 0.98 kb, respectively. The classification of this cloned DNA as a new type is based on the degree of cross-hybridization with 40 HPV types under conditions of varying stringency. A total of 106 benign and malignant skin lesions, as well as 71 malignant tumours of different origins, were screened for the presence of HPV-related sequences. In 2 out of 10 squamous-cell carcinomas and in 1 of 3 arsenic keratoses HPV 41 DNA sequences could be detected.

Fluorescence spectrophotometric study of structural alterations in the capsid of poliovirus.

Concerted structural alterations of viral proteins in the capsid of poliovirions are induced after adsorption to specific receptors on the host cells. Similar changes occur in vitro during exposure to low and high pH, elevated temperature or to denaturing agents. These structural alterations can be monitored conveniently by recording changes in the intrinsic fluorescence of the poliovirus-capsid and by following the fluorescence intensity after addition of ethidium bromide to virus particles. Application of these fluorescence techniques reveals that the uncoating of the virions in vitro occurs in two distinct steps: 1. entry of ions, e.g. ethidium bromide, 2. development of sensitivity of the virion RNA to RNase and release of the RNA. We confirm different structural stabilities of the virions at several pH values to elevated temperatures and a stabilizing effect of arildone on poliovirions.