[Color vision defects in patients with arterial hypertension]. / Farbsinnstörungen bei Patienten mit einer arteriellen Hypertonie.

PURPOSE: In view of the generally impaired vascular condition in patients with arterial hypertension, we were interested in their colour perception. METHODS: Patients (n = 35, f:m = 14:21, mean age 52 +/- 11 years) with arterial hypertension without damage in end-organs and normal subjects (n = 62, :m = 28:34, mean age 49 +/- 9 years) as a control group were included in this study. Exclusion criteria were other systemic or ophthalmological diseases. In addition to the ophthalmological examinations (visual acuity, refraction, intraocular pressure, slit lamp and fundus examination) the colour vision was tested by the colour arrangement test Roth 28-hue (E) desaturated under standard conditions: The background used was black cardboard, illuminated by two Osram fluorescent lamps (L36 W/12LDL Daylight) providing 2000 lux at the test table. RESULTS: The ophthalmological examinations in the patients and in the control group were normal. The patients with arterial hypertension had a significantly higher mean error score (median +/- mean absolute deviation 150 +/- 56, Mann-Witney U-test: p < 0.001) in the colour arrangement test than the control group (median +/- mean absolute deviation 72 +/- 53.4). A particular colour axis (blue-yellow or red-green) was not found. CONCLUSION: Although the ophthalmological examinations were normal we found a disturbed colour vision in patients with arterial hypertension. This has to be taken into account in colour vision testing to avoid diagnostic interferences between specifically ocular diseases (e.g. glaucoma) and arterial hypertension.

[Eosinophil cationic protein in a 39-year-old patient with Churg-Strauss syndrome]. / Eosinophiles kationisches Protein bei einer 39jährigen Patientin mit Churg-Strauss-Syndrom.

HISTORY AND CLINICAL FINDINGS: A 39-year-old woman in good health suddenly developed painful paraesthesia and incomplete paresis of all four limbs. Furthermore, arterial hypertension and tachycardia were found. The patient reported a history of chronic allergic rhinitis for 10 years and asthma one year. INVESTIGATIONS: Laboratory data showed an increased leucocyte count with a substantial increase in eosinophils in peripheral blood as well as in bone marrow. Nonspecific inflammatory markers such as erythrocyte sedimentation rate, C-reactive protein, fibrinogen as well as eosinophil cationic protein (ECP) were also increased. Histological investigations of a skin-muscle biopsy of the quadriceps revealed necrotizing vasculitis with extravascular granulomata and histiocytic giant cells. DIAGNOSIS, TREATMENT AND COURSE: Based on the diagnosis of Churg-Strauss syndrome treatment with methylprednisolone (500 mg every second day) was started, but was found to be ineffective after 10 days. Symptoms responded well to a subsequent course of 150 mg cyclophosphamide combined with 50 mg prednisolone per day. Pareses and pain were significantly reduced and all qualitative nerve functions returned to normal within two weeks of treatment. Laboratory parameters, especially the ECP, were similarly normalized. CONCLUSION: Churg-Strauss syndrome should be considered in the differential diagnosis of unexplained polyneuropathy. Determination of ECP may not only help in the diagnosis but does also facilitate monitoring of treatment and of further course of the disease.

[The diagnostic significance of alpha-MSH in malignant melanoma of man]. / Zur diagnostischen Bedeutung des alpha-MSH beim malignen Melanom des Menschen.

In malignant melanoma, melanocyte-stimulating hormone (alpha-MSH) has been found to influence the cellular metabolism of melanoma cells (c-AMP production, protein and RNA synthesis, and tyrosinase activation). In some publications elevated alpha-MSH levels have been described in melanoma patients. In the present study we used a commercially available radioimmunoassay to examine the alpha-MSH levels in patients with malignant melanoma and a control group consisting of apparently healthy volunteers (laboratory assistants) and dermatological patients without malignant tumours. The plasma alpha-MSH levels were (mean +/- SD) 12.2 +/- 12.9 for 37 melanoma patients (17 female, 20 male) and 7.9 +/- 3.5 pmol/l for 38 control persons (18 female, 20 male). The difference is significant according to the distribution-free U-test of Mann and Whitney. In 13 (35%) of the melanoma patients values were above the normal range defined by the 95.5% confidence limit. alpha-MSH cannot be classified as a typical tumour marker. Nonetheless, in our opinion alpha-MSH levels may be useful in monitoring melanoma patients with reference to prognosis and follow up during and after therapy.

[Effect of structure of hapten carrying model substances on contact reaction: DNP conjugates of stereoisomers of alpha-alanine following DNCB sensitization]. / Der Einfluss der Struktur haptentragender Modellsubstanzen auf die Kontaktreaktion: DNP-Konjugate der Stereoisomeren des alpha-Alanins nach DNCB-Sensibilisierung.

By means of epicutaneous tests under standard conditions we studied the cell-mediated contact sensitivity to dinitrophenyl (DNP) conjugates of the stereoisomeric amino acids L-alpha-alanine and D-alpha-alanine, respectively, in patients sensitized with dinitrochlorobenzene (DNCB). There was no difference in the number of positive skin responses with the two enantiomeric compounds DNP-L-alpha-alanine (16/26) and DNP-D-alpha-alanine (17/26). However, as in earlier studies, no patient has shown a positive reaction to the position-isomeric DNP-beta-alanine.

[Model antigens and their significance for occupational dermatology]. / Modellantigene und ihre Bedeutung für die Arbeitsdermatologie.

By means of epicutaneous tests we studied the contact hypersensitivity to DNP-amino acids in individuals sensitized to dinitrochlorobenzene (DNCB). We found a high incidence of positive skin responses to DNP-glycine, di-DNP-L-cystine, and DNP-L-alpha-alanine, but only in some cases DNP-beta-alanine induced skin reactivity. The results are discussed both in connection with the influence of varying molecular sizes and chemical structure on the immunological reactivity and the possibility to develop a beta-alanine containing protective ointment against protein-reactive haptens.

[Effect of low-molecular substances on E-rosette formation of human lymphocytes in vitro]. / Der Einfluss niedermolekularer Substanzen auf die E-Rosettenbildung humaner Lymphozyten in vitro.

The classical characteristics of T lymphocytes to form E rosettes with sheep red blood cells dependents on various endogenous and exogenous factors or substances present in the reaction medium. A concentration dependent inhibition of E rosetting with human lymphocytes in vitro was found after incubation with several drugs and occupational chemicals. A minimum effect was caused by dimethyl sulfoxide, benzene, sodium azide, and urea; a higher one was found with hydroxy derivatives of benzene, formaldehyde and the antiinflammatory drug ZIMET 49/79, whereas the strongest inhibition was effected after incubation with ethanol, the detergents sodium dodecyl sulfate and triton X-100, respectively, and the antipsoriatic drug dithranol (anthralin). The presence of serum proteins (20 per cent inactivated calf serum) reduces these effects.

[Effect of the chemical structure of low molecular weight hapten carriers on immunoreactivity]. / Zum Einfluss der chemischen Struktur niedermolekularer Hapten-Träger auf die Immunreaktivität.

Patients with demonstrated contact dermatitis to DNCB (dinitrochlorobenzene) were patch-tested using various dinitrophenyl (DNP) derivatives. These investigations revealed the varying sensitivities to the structural isomers DNP-L-alpha-alanine (59% positive) and DNP-beta-alanine (4% positive). These results are discussed both in connection with various sensitivity rates to other DNP compounds and published findings from the literature concerning the influence of structural factors on immune reactivity.

[Annual rhythm of the excretion of indole melanogen in human urine]. / Jahresrhythmik der Ausscheidung von Indolmelanogenen im menschlichen Harn.

Comparing the monthly indole melanogen mean values (4,100 single values within 5 years) in patients with malignant melanomas showing a normal urinary indole melanogen concentration we have found a seasonal effect with a maximum melanogen excretion in spring (March) and summer (July) and a minimum in autumn (September). These results are statistically significant. The possible importance of these seasonal influences for the prognosis in individual cases of malignant melanoma is discussed.

Magnetic resonance imaging and complex partial seizures.

Magnetic resonance imaging (MRI) is a new imaging modality with potential usefulness in the evaluation of patients with seizure disorders. We studied 100 consecutive patients with complex partial seizures comparing computerized cranial tomography (CCT) with MRI. Our study revealed 36 patients with CCT abnormalities. Of these, 30 (83%) had focal abnormalities. MRI demonstrated 45 patients with abnormalities, 34 (76%) were focal. Intracranial calcifications were not visualized by MRI, but were easily demonstrated by CCT. MRI was more sensitive in visualizing cerebral atrophy, abnormal cerebral vasculature, and lesions in the posterior fossa and suprasellar region. Most importantly, several patients who had normal CCTs had abnormal MRIs consistent with neoplastic lesions. As MRI becomes more available, this imaging modality along with EEG, should be the studies of choice in evaluating patients with partial epilepsy.

Monocular elevation paresis caused by an ipsilateral lesion.

A 52-year-old woman presented with a paresis of elevation of the right eye, equally severe in abduction and adduction (monocular elevation paresis). CT demonstrated a small, right-sided tumor of the mesodiencephalic junction. Monocular elevation paresis has been attributed to lesions of the contralateral pretectum, although proof has been lacking. Now, with documentation of an ipsilateral brainstem etiology, we can postulate a lesion affecting the upgaze efferents from the ipsilateral rostral interstitial nucleus of the medial longitudinal fasciculus.

Internal ophthalmoplegia resulting from acute orbital phycomycosis.

Phycomycosis is an opportunistic infection occurring in immunocompromised hosts. It is the most acutely fatal fungal disease known. Therefore, early recognition and treatment are essential. Ocular and orbital involvement is part of a rhino-orbital-cerebral form of the disease. The orbital apex syndrome is the hallmark orbital involvement. A case of phycomycosis with internal ophthalmoplegia alone is reported. The internal ophthalmoplegia is probably secondary to involvement at the apex of the orbit, although not sufficiently diffuse to result in the complete orbital apex syndrome.

Opsoclonus. Update on clinical and pathologic associations.

Opsoclonus is a bizarre oculomotor disturbance consisting of rapid, involuntary, repetitive conjugate eye movements in all directions. Clinically, it has been associated with infections, neoplasms, toxins, and drugs. Pathologically, there is no apparent consistently defined structural lesion. A case of opsoclonus with postmortem results is reported. Opsoclonus in adults and available autopsy data are reviewed.