Serum antibody titers in a systemic lytic therapy with streptokinase.

BACKGROUND: Anaphylactic reactions to streptokinase are rare but potentially life-threatening complications. Gamma E immunoglobulin (IgE) mediated mechanisms, probably due to streptococcal infections, have been implicated. We investigated the value of in vitro laboratory or dermatologic tests in predicting anaphylactic reactions due to streptokinase and the value of antistreptolysin titers (ASL) in predicting the amount of specific IgE (sIgE) and specific gamma G immunoglobulin (sIgG) neutralizing antibodies to streptokinase. METHODS: We measured serum levels of total IgE, streptokinase sIgE and sIgG, and ASL in 16 patients before and 9 and 41 days after streptokinase therapy. Immediately before therapy, intracutaneous testing with 100 IU streptokinase was done. RESULTS: Dermatologic testing did not identify patients prone to allergic reactions. Moreover, not all patients with increased sIgE levels had allergic reactions. These reactions were independent of the dose of streptokinase given. In spite of steroid prophylaxis, allergic reactions occurred in 3 of 16 patients, but none showed life-threatening anaphylaxis. Streptokinase sIgE and sIgG concentrations were closely related to ASL titers. CONCLUSIONS: Plasma levels of sIgG, sIgE, and ASL titers showed a good correlation. We believe ASL titers can be used for the estimation of neutralizing antibodies instead of streptokinase sIgG antibodies. Currently, no laboratory or dermatologic test allows reliable predictions of allergic reactions to streptokinase.

[Anaphylactic reaction in streptokinase therapy]. / Anaphylaktische Reaktion unter Streptokinase-Therapie.

Streptokinase is used worldwide as thrombolytic agent. Indications are deep vein thrombosis, arterial thrombosis and embolism, arteriovenous cannula occlusions, acute coronary artery thrombosis, and acute renal vein thrombosis. The major drawback in comparison with other thrombolytic drugs is its antigenicity. Allergic reactions have been reported but the underlying mechanisms have not yet been fully elucidated. A 58 year-old man with acute myocardial infarction developed an anaphylactic reaction immediately after commencement of streptokinase infusion, although immunological laboratory findings were not affected. The patient had no history of prior exposure to streptokinase, infections with streptococci, or chronic allergic reactions. 2 months after streptokinase therapy increased plasma levels were detected of specific IgG antibodies to streptokinase. The levels of specific IgE antibodies to streptokinase and other anti-streptococcal antibodies were within the normal range. A prick test performed 4 months later with 100 I.U. streptokinase was unremarkable. The problems of such allergic reactions are discussed on the basis of this case report and a review of the literature.

[Lethal animal pox virus infection in an atopic patient simulating variola vera]. / Letale Tierpockeninfektion bei einem Atopiker unter dem Bild einer Variola vera.

An 18-year-old patient requiring steroid treatment for severe bronchial asthma and with atopic dermatitis acquired a cowpox-like virus infection clinically similar to smallpox from a domestic cat as carrier. In spite of intensive care, with controlled pressure breathing and the last available vaccinia hyperimmunoglobulin, the patient died of pulmonary embolism although viral spread had ceased some days before.

[Malignant melanoma in café-au-lait spot]. / Malignes Melanom in Café-au-lait-Fleck.

A 17-year-old female patient developed a superficially spreading malignant melanoma (level III, thickness 0.91 mm) on a typical café-au-lait spot. There were no metastases, as yet. On the basis of this unusual case, we discuss the incidence of development of malignant melanoma on melanotic spots.

[Sanitizing a hospital hot water system contaminated with Legionella pneumophila]. / Sanierung eines mit Legionella pneumophila kontaminierten Krankenhaus-Warmwassersystems.

A number of measures were taken to control Legionella pneumophila in a hospital hot water system over a period of 18 months, including (i) raising the temperature of the water leaving the central storage tanks from initially 55-60 degrees C to approximately 73 degrees C, (ii) heat shock treatment of the whole system with water temperatures above 70 degrees C and (iii) increasing the daily return flow from the hospital circulation system from initially 30 m3 to 120 m3. In addition, (iv) three UV irradiation devices were installed on the inlet and outlets of the storage tanks and (v) an attempt was made to decontaminate the water system by means of CO2. Measures (i) and (iii) were demonstrated to be effective for permanent control of Legionellae in the system. Measures (ii) and (v) proved to have only a short term effect of several days and measure (iv) did not show any effect on the presence of Legionellae at all. The extent of Legionella contamination of the water samples correlated negatively with water temperature and depended on the position of the outlets within the hospital. Different pipe materials (copper, plastics) could not be shown to have any influence on the extent of water contamination with Legionella. The findings of the survey indicate that especially the peripheral areas of the hot water system were colonized by Legionellae.

[Cutaneous sarcoidosis]. / Kutane Sarkoidosen.

We report on three clinical cases of cutaneous sarcoidosis. One of them was associated with erythema nodosum, another with erythema annulare centrifugum. The third case showed an annular lesion having persisted for 10 years; X-ray of the lungs revealed stage 3 disease.

[Malignant fibrous histiocytomas]. / Maligne fibröse Histiozytome.

Malignant fibrous histiocytomas of the storiform pleomorphic type were found in the lower legs of two patients, 79 and 42 years of age. In the first, dermatofibrosarcoma protuberans, in the second, squamous cell carcinoma, had to be discussed. In the first patient, the tumor arose in the area of a preexisting paresis of the superficial peroneal nerve; the second patient developed the tumor in fistulous osteomyelitis existing since childhood.

[Effect of infrared radiation on the kinetics of the guinea pig's epidermis cells. Comparison with UV radiation effect]. / Einflüsse der Infrarot-Bestrahlung (IR) auf die Kinetik der Meerschweinchen-Epidermiszellen. Vergleich zur Wirkung ultravioletter Strahlen.

In vivo exposition of guinea pig epidermal cells to infra-red irradiation (IR) led to significant, biphasic reduction of the proliferating activity after 6 h and 72 h. Not before 168 h after exposure, the proliferating activity rose above the normal rate. The quantitative alterations of DNA-proliferating cells went along with prolongation of the S-phase and the cell cycle. UV-irradiated cells react earlier by reduction of the DNA-proliferating activity directly followed by stages of hyperproliferation.

[Syringocystadenoma papilliferum as a differential diagnosis of a carcinoma of the lower lip]. / Syringocystadenoma papilliferum als Differentialdiagnose eines Unterlippencarcinoms.

A 56-year-old patient showed a skin-colored tumor of the lower lip which had been photographically documented since his 10th year of age. On account of the localisation, increase of size during the last few months, as well as irregular epithelial hyperplasia observed in a punch biopsy from the periphery, we suspected the tumor to be a squamous cell carcinoma. Histological examination, however, revealed syringocystadenoma papilliferum.

[Effects of infrared and UVA rays on the human skin and their efficacy in the treatment of atopic dermatitis]. / Wirkungen von Infrarot- und UVA-Strahlen auf die menschliche Haut und ihre Wirksamkeit bei der Behandlung des endogenen Ekzems.

Radiation with ultrared light (UR) and with a supposed pure UVA high pressure tube leads to increase of the skin surface temperature, which is linear during UR radiation and causes pain at 42 degrees C. During UVA radiation, the skin surface temperature increases in a parabolic curve and approximates 42.3 degrees C asymptotically. There is no pain. Following both UR and UVA, erythema occurs at 41.4 degrees C. UVA additionally results in immediate pigmentation dependent on the dose between 6 and 20 J/cm2. UR does not induce any pigmentation. The erythema induced by UR disappears completely within 6 hours. Corresponding to the dose, the erythema persists up to 7 days after UV radiation. Immediate and delayed erythema obviously overlap. The pigmentation shows a biphasic reaction. There is a maximum immediately at the end of UV radiation, reduction between 6 and 24 hours after radiation. The course of erythema and pigmentation indicates a clinically relevant part of UVB in the emission spectrum supposed to be pure UVA. A therapeutical trial was performed in 40 patients suffering from severe atopic dermatitis. In a group of 10 patients, daily UR radiation up to beginning pain showed good results within 3 weeks. The therapeutic effects were even better in another group of patients radiated with suberythematous doses of UVA daily for the same time. UVA radiations twice a week for 6 to 8 weeks were less effective.

[Side effects and risks of phototherapy]. / Nebenwirkungen und Risiken der Phototherapie.

Interference factors of UV-therapy are among others the absolutely unknown biological activities of visible and ultra red wavelengths, which represent the main part of the energy emitted from all UV-sources. They produce a rise of the skin surface temperature up to 42-44 centigrades immediately followed by a reticulate erythema as well as a proliferative response of basal cells, which goes synchronously with that after SUP or UVA application but does not result in hyperproliferation. Acute side effects are direct toxic activities of UV-light with sunburn, up to severe bullous reaction, but without scarring; exacerbation of UV-sensitive dermatoses, internal diseases, and modulations of the immune system.

[The effect of a tar admixture to dithranol-salicylic-acid-white-petrolatum therapy on the cytokinetics of psoriasis]. / Einfluss von Teerzusatz zur Cignolin-Salicylsäure-weisse-Vaselin-Therapie (CSV) auf die Zytokinetik der Psoriasis (TCSV-Therapie).

The initial stimulation of DNA-synthesis after application of dithranol as single agent is completely inhibited by addition of tar. The autoradiographic analyse indicates that the good clinical effect of the new antipsoriatic therapy with TCSV may be due to suppression of dithranol-caused irritation by tar. But, restored cytokinetic values do not correspond to clinical remission of psoriasis.

[Pressure-induced pseudoangioma of obese women]. / Druckinduziertes Pseudoangiom adipöser Frauen.

Due to the pressure by the straps of brassieres, lichen sclerosus-like lesions have been observed on the shoulders of obese women with hyperplastic mammae. Histologically the lesions are characterized by hyperkeratosis, acanthosis and pseudoangionatous proliferation of the capillaries in the dermis. Elastic fibers are sparse, but there is no marked edema and only a moderate perivascular infiltrate of mononuclear cells.

[CRSET syndrome: association with erythema figuratum]. / CRSET-Syndrom: Assoziation mit Erythema figuratum.

We report on a 69-year-old woman showing simultaneous occurrence of CRSET-syndrome and erythema figuratum. As far as we known, the association of these two diseases has not been observed before.

[Latent sensitization to bee and wasp venoms]. / Latente Sensibilisierung auf Bienen- und Wespengift.

IgE-RAST with bee and wasp venom was performed on 200 persons without any allergic history. Specific IgE antibodies against bee and/or wasp venom were found in 55 persons (27, 5%); in 14 persons of these against bee, in 29 against wasp and in 12 against bee and wasp venom. Specific IgG antibodies were only found in 16, 4% of the silently sensitizated persons. Therefore, the lack of symptoms in the remainder of this group cannot be explained by the presence of blocking IgG antibodies.

[Leser-Trélat syndrome, erythema anulare centrifugum Darier, breast cancer and basaliomas in a patient]. / Leser-Trélat-Syndrom, Erythema anulare centrifugum Darier, Mammacarcinom und Basaliome bei einer Patientin.

A 46 year old woman had suffered from Erythema anulare centrifugum Darier (EAC) since 20 years. During a rush of the erythema numerous seborrhoic keratoses appeared (Leser-Trélat sign/LTS). Clinical examination revealed a ductular carcinoma of the breast. During the last two years, both types of lesions increased although the tumor had been treated. In addition, the patient developed several basal cell epitheliomas at forehead and chest.

[Pemphigoid lichen ruber]. / Lichen ruber pemphigoides.

In two patients with exanthematical lichen planus large bullae occurred in preexisting papules during a severe rush of disease. The bullae were formed subepidermally but Ig G deposits were not found. So both patients suffered from lichen planus pemphigoides as primarily described, and not from bullous pemphigoid with lichen planus.