[Diagnosis and treatment of nephrolithiasis. What is established?]. / Diagnostik und Therapie der Nephrolithiasis. Was ist gesichert?

BACKGROUND: Kidney stones are a common and increasing problem worldwide. Nephrolithiasis is frequently a chronic disease given the risk of recurrence following passage of a first stone. OBJECTIVES: In the present article, an update on the diagnosis and treatment of kidney stones relevant for internal medicine physicians is provided. METHODS: This review is based on a selective literature search and our own work. RESULTS AND CONCLUSION: The diagnosis of kidney stones is based on the clinical history and physical examination. Confirmatory radiologic tests include noncontrast computerized tomography or ultrasonography with both techniques having recently been shown to have equivalent overall outcomes. The therapy of kidney stones is based on the clinical presentation and diagnostic findings (e.g., fever, response to pain management, and demonstration of relevant obstruction) as well as location, size, and composition of the stone. If invasive treatment is being considered, the urology department should be consulted. Given the high risk of recurrence, stone analysis must be performed as well as the concentration of lithogenic and litholytic substances measured in a 24-h urine collection. The newly established recurrence of kidney stone nomogram (ROKS nomogram) identifies kidney stone formers at greatest risk for a second symptomatic episode who may benefit from medical intervention.

Comparative study of a block copolymer morphology by transmission electron microscopy and scanning force microscopy.

Using transmission electron microscopy (TEM) and scanning force microscopy (SFM) together, it was possible to verify important structural features of a nanostructured bulk material such as the kp-morphology in an ABC triblock copolymer. By applying suitable imaging techniques during the SFM measurements it was possible to determine the morphology without additional manipulation steps in between. In comparison, TEM investigations on this type of material usually require selective staining procedures prior to the measurement. Also electron beam damage is often encountered during TEM measurements especially if components such as poly(methacrylates) are present. In contrast, SFM measurements can be assumed not to significantly change the phase dimensions of the components.

Conditioning polymers in today's shampoo formulations - efficacy, mechanism and test methods.

Today's shampoo formulations are beyond the stage of pure cleansing of the hair. Additional benefits are expected, e.g. conditioning, smoothing of the hair surface, improvement of combability and lather creaminess. Cationic polymers play an important role in providing many of those features. Therefore, within the last few years their use in shampoos has increased greatly. In the only last two decades, shampoo designation has gradually changed from '2-in-1' to '3-in-1' and then to 'multifunctional', as at present. The consumer demands products which live up to their promises. Modern shampoos contain a wide variety of ingredients such as co-surfactants, vitamins and pro-vitamins, protein derivatives, silicones, natural-based plant extracts and other 'active ingredients', but there is still a need for conditioning polymers. The specific objective of this study is to assess the conditioning efficacy of cationic polymers and to investigate their mechanisms in a shampoo system. The investigations were carried out on formulations that contained sodium lauryl ether sulphate and different cationic polymers, e.g. Polyquaternium 7, 10, 11, cationic guar gum and Luviquat Care (Polyquaternium 44), a new branched copolymer of vinylpyrrolidone (VP) and quaternized vinylimidazolium salts (QVI). We used test methods relevant to the applications in question, such as combing force measurements, the feel of the hair and the creaminess of the lather, to assess the efficacy. Atomic force microscopy and electrokinetics (streaming potential) were used to detect polymer residues on treated hair. All the polymers under investigation improved the overall performance of the shampoo formulations. This was demonstrated by means of combing force measurements, sensorial tests and analytical methods, namely zeta potential measurement and atomic force microscopy. Polyquaternium 44 exhibited the best conditioning properties on wet hair without sacrificing removability or absence of build-up. The latter are the most striking weaknesses of cationic Guar Gum-based polymers. Polyquaternium 10 can also be removed from the hair after rinsing with anionic surfactant but it does not perform as well as Polyquaternium 44 in the fields of wet combability and sensorial criteria such as lather creaminess and feel of the hair. We postulate that the outstanding properties of Polyquaternium 44 as a conditioning agent for shampoos are due to its tailor-made 'branched' structure. There is a clear correlation between the molecular weight and the efficacy of the new copolymers of VP and QVI. Only cationic polymers with a very high molecular weight are effective as conditioners in shampoos based on anionic surfactants. Surprisingly, they do not have to have a high cationic charge. On the basis of all our results, our postulation is that the polymer residue which is responsible for conditioning does not form a flat layer on the hair. Rather, the polymer residue adsorbs with the few cationic moieties, while the uncharged part of the polymer forms loops, which are orientated away from the hair and which are responsible for the reduced friction between hairs.

Naevi spili, Café-au-lait spots and melanocytic naevi aggregated alongside Blaschko's lines, with a review of segmental melanocytic lesions.

This is the first case in the literature describing naevi spili, café-au-lait spots and melanocytic naevi aggregated along-side Blaschko's lines. The pattern of melanocytic lesions in our patient is different from the congenital pigmentary syndromes and the segmental distribution of melanocytic naevi, the quadrant distribution of dysplastic naevi or the partial unilateral lentiginosis which here are shortly reviewed. The distribution may be a result of a somatic mutation occurring at an early stage of embryogenesis when neural structures had already been formed.

[Allopurinol in treatment of cutaneous sarcoidosis]. / Allopurinol in der Behandlung der kutanen Sarkoidose.

Several reports more than ten years ago provided evidence that allopurinol may be effective for cutaneous sarcoidosis. We therefore treated two patients with histologically confirmed scar sarcoidosis and two with nodular sarcoidosis. A daily dosage of 300 mg allopurinol was given over a period of 4-7 months as single drug therapy. In both patients with scar sarcoidosis, the skin manifestations completely regressed while in the patients with nodular sarcoidosis there was significant improvement. The concomittant pulmonary involvement in two patients was unpredictable, in one patient improved while the other was deteriorated, The mode of action is still unclear but because of the positive results and the low rate of side effects, allopurinol seems a reasonable agent for treating cutaneous sarcoidosis.

[Minocycline-induced hyperpigmentation]. / Minozyklin-induzierte Hyperpigmentierung.

A common adverse effect of minocycline therapy is cutaneous pigmentation. We describe two patients who presented with hyperpigmentation caused by minocycline. One patient, aged 54 years, had taken minocycline due to lung silicosis for 3 years before black pigmentation of the face occurred. The other 49 year-old patient developed grey-black hyperpigmentation on both lower legs after a 6-month therapy with minocycline for folliculitis. This patient was treated with the Q-switched ruby laser and the pigmentation resolved in the treated area. The different clinical and histological forms of minocycline-induced hyperpigmentation are discussed.

[Sugar beet pollen allergy as a rare occupational disease]. / Zuckerrübenpollenallergie als seltene Berufserkrankung.

Although there are a few isolated reports in the literature suggesting that sugar beet pollen is highly antigenic, hypersensitivity to components of sugar beet is not a common disease. We report a 29-year-old man with a history of atopic dermatitis who developed both contact dermatitis and allergic rhinitis from sugar beet pollen through his job in a seed nursery.

[Hydroa vacciniforme]. / Hydroa vacciniformia.

HISTORY AND CLINICAL FINDINGS: For three years, each time the day after intensive exposure to the sun a 5-year-old girl developed moderately painful erythema and blisters on uncovered parts of her body which subsequently healed with scarring. There was no increased photosensitivity among members of her family. There were numerous blisters and bullae, some of them confluent, filled with serous fluid on her back, on her arms an in the face. There were varioliform scars on the extensor surfaces of her arms. INVESTIGATION: There were no porphyrins in red cells, serum or urine. The characteristic skin changes were reproduced on exposure to UV-A. These findings established the diagnosis of hydroa vacciniforme. TREATMENT AND COURSE: Prolonged sun exposure was to be avoided and protective ointment was prescribed together with administration of beta-carotene, 25 mg twice daily. CONCLUSION: In children light-induced skin changes which heal with scarring may be due to hydroa vacciniforme.

[Positive tuberculin reaction in sarcoidosis]. / Positive Tuberkulinreaktion bei Sarkoidose.

Scar sarcoidosis is one of the rare cutaneous manifestations of sarcoidosis. Apart from the clinical picture, suppression of the cell-mediated immunity can often be determined when tuberculin tests and testing for recall antigens are carried out. In the present case of a 68-year-old woman patient scar sarcoidosis and pulmonary sarcoidosis were detected. Remarkably, a strongly positive tuberculin reaction was found, while acute tuberculosis and former BCG vaccination were excluded. Both references in the literature and the case presented demonstrate that a positive tuberculin test, while very unusual in sarcoidosis, does not however, preclude the diagnosis. On the basis of some case reports in the literature, our patient was treated with allopurinol; impressive improvement of both the skin and the pulmonary manifestations was noted. Despite the well-known phenomenon of spontaneous regression in sarcoidosis, we recommend a clinical trial with allopurinol as this substance is well tolerated.

Recurrent inflammation in incontinentia pigmenti of a seven-year-old child.

A young girl has undergone the typical skin manifestations of incontinentia pigmenti, leaving now only discrete hyperpigmentation on the flexor sides of the lower extremities. Each time when she has a feverish infection, a recurrence of inflammation can be seen within the hyperpigmented areas. At the same time when the fever subsides, the acute skin manifestations disappear as well. The combination of recurrent inflammatory skin manifestations within the hyperpigmented skin areas of incontinentia pigmenti and fever is unique. The reasons for this phenomenon and for its strict limitation to the areas of incontinentia pigmenti remain unclear.

[Value of nucleolus organizer regions (AgNORs) in dermatologic oncology]. / Wertigkeit der Analyse Nukleolus-organisierender Regionen (AgNORs) in der Dermatoonkologie.

Nucleolus-organizing regions (Ag-NORs) are silver-stained loops of DNA transcribing to ribosomal RNA. Quantitative analysis helps to differentiate normal tissue from malignant tissue and can be used for diagnosis in several kinds of tumours. The analysis of AgNORs can also be used in dermatopathology for diagnostic and prognostic purposes. Apart from skin tumours such as basal, cell carcinomas and squamous cell carcinomas, this technique is of interest principally for melanocytic lesions. Benign naevi can be distinguished from malignant melanomas by simple counting of the AgNOR dots. For the differentiation of dysplastic naevi, Spitz naevi and malignant melanomas, this parameter alone is not sufficient. By combination of several AgNOR parameters (number, size, pattern of dispersal) only, significant differentiation could be achieved. The prognostic value of AgNORs remains to be examined.

UV-A-provoked localized bullous pemphigoid.

A 71-year-old woman had noticed the development of blisters on her forehead 4 months before she was referred to our department. Treatment with oral corticosteroids resulted in complete healing, but new blisters subsequently developed on the face, neck and backs of the hands. After the possibility of phototoxic and photoallergic reactions, as well as an abnormal porphyrin profile, had been excluded, the diagnosis of bullous pemphigoid was made by histological and direct immunofluorescent examination. UV-A provocation on the upper arm produced lesions histologically and immunohistochemically typical of bullous pemphigoid. Of particular importance was the fact that the blisters were limited strictly to light-exposed skin areas.

Effective postcoital quinolone prophylaxis of recurrent urinary tract infections in women.

A total of 33 sexually active, premenopausal and postmenopausal women, suffering from recurrent urinary tract infections was randomized to receive postcoital prophylaxis with a dose of either 100 mg. ofloxacin (12), 200 mg. norfloxacin (11) or 125 mg. ciprofloxacin (10). While 130 urinary tract infections occurred in these patients during a mean of 8 months before postcoital quinolone prophylaxis, only 1 occurred during a mean of 15 months following prophylaxis. This difference was statistically highly significant. Each of these patients ingested a mean of 117 quinolone doses per year of postcoital prophylaxis. Before prophylaxis 74% of the introital cultures yielded gram-negative enterobacteria (mainly Escherichia coli), whereas only 11% yielded the same bacteria following prophylaxis. Postcoital oral prophylaxis with minimal quinolone doses is highly effective in the prevention of recurrent urinary tract infections in women, because it achieves high urinary bactericidal concentrations, and clears the majority of the introital and urethral Enterobacteriaceae without inducing resistance to the quinolones despite long-term treatment. This prophylaxis is highly recommended because of its ease of compliance, preservation of drug efficacy, lack of toxicity and cost-effectiveness. Postcoital quinolone prophylaxis is as good as or better than daily quinolone prophylaxis and uses only a third of the amount of drug consumed in daily prophylaxis.

[Adenoid cystic sweat gland carcinoma. A clinicopathologic and immunohistochemical study]. / Das adenoid-zystische Schweissdrüsenkarzinom. Eine klinisch-pathologische und immunhistochemische Studie.

Adenoid cystic carcinoma of the skin is one of the rarest sweat gland tumours. We have studied two cases of adenoid cystic sweat gland carcinoma clinically, histologically and immunohistochemically. One tumour was located on the occiput of an 18-year-old male patient, while the other developed on the back of a 49-year-old woman. Histologically, both carcinomas were characterized by basaloid tumour cells showing the typical adenoid-cystic growth pattern. The cells were arranged in solid, cribriform, tubular and cystic aggregates, which were surrounded by mucoid, Alcian blue material. Immunohistochemically, the tumour cells showed coexpression of cytokeratins typical of stratified epithelia (CK1/5/10/14) and cytokeratins of the simple epithelial type, namely CK7, CK8, CK18, and CK19. Coexpression of these cytokeratins is usually observed in normal fetal sweat glands, but not in adult sweat glands.

Nd:YAG laser hyperthermia in the treatment of recalcitrant verrucae vulgares (Regensburg's technique).

Heat therapy of cutaneous diseases has been used for decades. During the last years several kinds of energy sources, including electromagnetic energy from radiofrequency, microwaves and sonic energy from ultrasound, have been used to produce local hyperthermia. The general principle of this treatment is based on the fact that disease tissue which is being treated is more sensitive to the effects of elevated temperature than normal tissue and thus less able to recover after heat exposure. We report the case of a 54-year-old female patient with recalcitrant verrucae vulgares on the little finger of her right hand and on her left sole, who was treated with Nd:YAG laser hyperthermia. Laser energy was applied twice with an interval of 6 weeks. Laser output power was 10 W, spot size 8 mm and irradiation time up to 20 s. By this technique it was possible to receive a surface temperature of about 40 degrees C for 30 s. After hyperthermia no skin changes like whitish discoloration, blistering or crusting were observed. After the patient had completed the second course a total remission took place. No recurrence was seen in a follow-up period of 3 months. This method could be used in the treatment of recalcitrant warts on the fingers and hands, periungual and other parts of the body including plantar surfaces.