Successful removal by ruby laser of darkened ink after ruby laser treatment of mismatched tattoos for acne scars.

Cosmetic tattoos are becoming increasingly popular. Elimination of cosmetic tattoos is sought because of misplacement or migration of tattoo pigment, allergic reactions to the various pigments or dissatisfaction of the customer for various reasons. Removal of unwanted pigment is a domain of laser surgery using various Q-switched laser systems, such as the ruby, alexandrite, pulsed dye and Nd:YAG lasers. Dark colours are easily removed by these lasers, whereas red, pink and skin-toned pigment may turn black if exposed to Q-switched laser light. This ink-blackening occurs because Q-switched lasers heat up the pigments, which consist of ferric oxide, and reduce them into ferrous oxide, which is black. Laser-induced black ink is not always readily removed. A successful ruby laser-removal of laser-induced blackened cosmetic tattoos for acne scar camouflage is reported. The advantageous outcome in this case contrasts with other published cases where laser-darkened pigment had to be removed by other measures, or was permanent. Test site treatment can limit the problem to some degree but, in addition to test-treating, some kind of 'tattoo identification card' could help to prevent problems in this field and allow 'in vitro' test treatment.

[Modern wart therapy]. / Moderne Warzentherapie.

A description of therapeutic modalities for the treatment of warts is given. Depending on localisation and types of warts, a variety of therapeutic modalities are available, which often will lead to eradication of the wart virus infection. It is important to choose therapies with low scarring potential.

[The enigma of Kaposi sarcoma]. / Das Enigma Kaposi-Sarkom.

The epidemiology of AIDS-associated Kaposi's sarcoma (KS) points to a sexually transmittable disease. Despite the fact that a recently discovered new herpesvirus has been detected in all forms of KS (Aids, classic, african and immunosuppressed--KS) its role remains to be further established, since a simple infection cannot account for all epidemiologic findings in KS. Various cytokines seem to play an important role also. The effect of human chorionic gonadotropin on KS can explain the different incidence of KS in males and females. Whether all forms of KS indeed have common causes, today, seems doubtful.

Detection of human papillomavirus in vulvar carcinoma. A study by in situ hybridisation.

Fourty-four specimens of invasive cancers of the vulva, including 38 primary invasive squamous carcinomas, were analysed by in situ hybridisation with biotinylated HPV 6/11, 16 and 18 DNA probes. Four (9%) of the 44 carcinomas were positive for HPV DNA: three (7%) for HPV 16 DNA and one (2%) for HPV 6/11 DNA. HPV DNA was found only in squamous carcinomas. Of the 38 primary squamous carcinomas, 11% were positive (8% HPV 16, 3% HPV 6/11). The overall 5-year survival was 48.7%, 48.5% for the squamous carcinomas and 50.0% for the HPV DNA positive patients.

[Oral hairy leukoplakia in patients with kidney transplantation]. / Orale Haarleukoplakie bei nierentransplantierten Patienten.

Oral hairy leukoplakia was initially reported only in HIV-infected patients and was considered pathognomonic for HIV infection. The presence of Epstein-Barr virus and the decrease in Langerhans cells seem to be necessary for the development of oral hairy leukoplakia. HIV antigen is not present in oral hairy leukoplakia. We report on seven renal transplant recipients with oral hairy leukoplakia. In six of these patients no HIV infection was present. All patients showed marked immunosuppression following a vigorous immunosuppressive regimen. Five patients each had several rejection episodes, which were treated with further immunosuppressive therapy in addition to the basic immunosuppressive regimen. One patient was infected with HIV from the renal graft and another suffered from liver cirrhosis with portal hypertension caused by chronic hepatitis B infection. We believe that oral hairy leukoplakia is a marker for severe immunosuppression that is not necessarily associated with HIV infection. Organ transplant recipients undergoing dermatological check-up should be examined for oral hairy leukoplakia.

[Anal condylomata acuminata. A prospective comparison of HIV positive and negative patients]. / Anale Condylomata acuminata. Ein prospektiver Vergleich von HIV-positiven und -negativen Patienten.

Between July 1986 and May 1987 23 patients suffering from anal condylomata acuminata were treated at the University Hospital of Zurich. The influence of HIV-infection on the disease is described. An almost equal frequency of recurrencies between positives and negatives was observed in a three year follow-up time. However, in positive patients recurrence was earlier and much more extensive. A two-stage procedure which sometimes is advocated in very extensive lesions gave very bad results in HIV positives. We use a radical excision by electrocoagulation on the mucosa and perianally and avoid circular necrosis in the lower anal canal only. Infectious complications are not to be feared except in patients with symptomatic HIV-infection resulting in the recommendation for a antibiotic prophylaxis in such cases.

Carcinoma of the cervix uteri and risk factors.

A prospective study included 210 patients and 100 healthy individuals in whom risk factors for the onset of malignant disorders of the cervix uteri were investigated. The following parameters were analyzed: age, profession, religious affiliation, former pregnancies, chronic irritative process on the cervix uteri, socio-economic status, heredity, contraceptive usage, smoking, sexual life and presence of the human papilloma viruses in the injured and healthy cervix. The results of the research emphasized the relevant risk factors for the genesis of the disease. They are presented in an original sheme. The central place in the pathogenesis of the disease is taken by the existing metaplasia on the portio vaginalis uteri and its contact with definite types of human papilloma viruses. The risk factors that contribute to the genesis of metaplasia and cervical infection by human papilloma viruses proved to be of great importance for the appearance of disorder. The adolescent period, the chronic irritative process on the portio vaginalis and the long-term use of hormonal contraceptives influence the genesis of metaplasia. Early sexual life, the changing of sexual partners, the sexual life of male partners, poor sexual hygiene, and the use of nonbarrier contraceptive devices favour the development of human papilloma viral infections of the cervix uteri.

HPV 16-positive bowenoid papulosis and squamous-cell carcinoma of the anus in an HIV-positive man.

A homosexual man in stage IV of HIV infection, who suffers from HPV 16-positive bowenoid papulosis of the anal region, is described. In one area the patient developed an HPV 16-positive squamous-cell carcinoma of the anus. Bowenoid papulosis represents a squamous-cell carcinoma in situ, and usually follows a benign clinical course. The possibility exists that immunocompromised individuals are at higher risk to develop cancer on the basis of bowenoid papulosis.

[Human papillomavirus types and cervical neoplasia]. / Tipovi humanih papiloma virusa i cervikalne neoplazije.

The pathological cells of the cervix uteri were examined for the presence of some types of human papilloma viruses (HPV) by DNA-hybridization and by the Southern blot method. Different degrees of neoplasia were found in the majority of these pathological changes of the uterus. The control group of patients included in the study had normal clinical, cytological and colposcopical results. Two parameters were identical both in the examined and the control patients. Types 6/11 were found in neither of the groups examined. The control patients had types 16/18 HPV in 8.3% of cases, while the frequency of these types was much higher in the examined group; it depended on the phase of the disease. These types were not detected in pathological lesions of CIN I; 40% of patients with CIN II had them, and 7.3% of patients with CIN III were positive to types 16/18 HPV. The majority (75%) of the examined samples of invasive neoplastic cervical lesions were positive to the presence of HPV 16/18.

Human papillomavirus-35-positive bowenoid papulosis of the anogenital area and concurrent human papillomavirus-35-positive verruca with bowenoid dysplasia of the periungual area.

We describe a 42-year-old woman with human papillomavirus (HPV)-35-positive bowenoid papulosis in her anogenital region and HPV-35-positive verruca with bowenoid dysplasia on her right ring finger. The anogenital lesions were diagnosed 11 years before the lesion on her finger developed. We were not able to cure her bowenoid papulosis, since new lesion formation occurred continuously. As pruritus of the anogenital area was always present, scratching may have resulted in autoinoculation. The fact that a "mucosal-type" HPV, which was cloned from a cancer of the uterine cervix, was detected in a dysplastic periungual lesion seems noteworthy. Viral copy numbers appeared to be much higher in the periungual lesion, indicating that in our patient HPV-35 was able to replicate well outside the anogenital area. There are as yet insufficient data on the epidemiology of HPV-35 to conclude how common extragenital infection with HPV-35 is.

Warts in fish handlers.

Fish handlers frequently suffer from hand warts. The clinical form and HPV type in these lesions were studied. Eleven individuals (10 fishmongers and one fisherman) with multiple hand warts were examined clinically and samples from their warts examined by Southern blot and reverse blot analysis. Clinically, with one exception, the warts were of the common type. HPV DNA was detected in all but one individual. HPV4 was found in one sample, HPV1 related virus in three, a virus hybridizing with both HPV27 and HPV2 in five (four individuals) and HPV7 in seven (six individuals). More than one type was detected in four individuals. HPV7 infection was related to the greater length of time spent in handling fish. These findings indicate that HPV7 is not, as was previously thought, found exclusively in those handling butcher meat and suggest that environmental conditions may be a factor in the clinical manifestation of HPV7 infection. The exact nature of a virus designated HPV2/27 and the significance of its presence in these fish handlers remains uncertain.

[Prevalence of cytomegalovirus, hepatitis B and HIV-1 antibodies in healthy blood donors, hospital patients, kidney transplant recipients, i.v. drug addicts and homosexuals]. / Prävalenz von Cytomegalievirus, Hepatitis-B- und HIV-1-Antikörpern bei gesunden Blutspendern, Spitalpatienten, Patienten vor Nierentransplantation, i.v.-Drogenabhängigen und Homosexuellen.

Between 1987 and 1988 592 serum samples were analyzed in order to determine the prevalence of cytomegalovirus (CMV), hepatitis-B and HIV-1 antibodies among healthy blood donors and different risk groups in the region of Zurich, Switzerland. Samples from 100 healthy blood donors, 100 hospital patients, 100 renal transplant recipients, 142 iv drug addicts and 150 homosexuals were analyzed. Among 111 (74%) of the 150 homosexuals studied, antibodies against CMV were identified. On the other hand, only a third of the remaining probands proved to be anti-CMV positive (26-37%). All the groups aged between 20 and 39 years showed an increase in anti-CMV frequency with advancing age. Among the 47 homosexuals aged between 20 and 29 years, 30 (64%) were already anti-CMV positive. The relevance of CMV as a sexually transmissible disease is discussed.

Herpes simplex virus infections: new concepts in an old disease.

This paper reviews recent clinical and laboratory investigations on herpes simplex viruses (HSV). New findings add to our knowledge about factors influencing HSV infection such as site of infection, virus type and they also point to the importance of the immune system for the outcome of infection. It appears that circumstances at the time of primary infection can modify the type of immune response generated and affect the likelihood of later recrudescence. One of these factors is UV light which seems to act via a photoisomer [cis(Z-)urocanic acid] on the immune system.