Metastatic malignant acrospiroma of the hand.

We present the case of a 37-year-old man with multiple pulmonary metastases of a primarily unknown primary tumour. Thorough revision of the medical history yielded that he had already passed three resections of a right palmar mass, which had been described as a benign tumour. Clinical examination showed a thickened scar with a suspicious palpable mass in the right hand. Excision of this scar and the tumour mass with histopathological examination now revealed a malignant acrospiroma. Resection of the pulmonary metastases histologically also confirmed a malignant acrospiroma. The following radical resection of the metacarpals II and III with the index and middle finger under the assumption of a wide compartment resection achieved tumour free margins and proved to be efficient with the patient being relapse free for 4 years from this operation. Although the prognosis of this tumour is generally unfavourable this particular case demonstrates the value of a radical surgical resection as the mainstay of treating such highly malignant sweat gland tumours of the hand.

Characterization of antigens and allergens in hypo-allergenic infant formulae.

The antigenicity and allergenicity of so-called hypo-allergenic infant formulae is mainly determined by the degree of hydrolysis and ultrafiltration. Five different formulae were investigated by means of immunoblotting and RAST in order to characterize the antigens and allergens regarding their molecular weights, molecular origin and their ability to bind human IgG and IgE antibodies: A non hydrolysed infant formula (I-F), a mixture of the major cow's milk proteins (PM), a whey-based infant formula (W-H), a whey-based and ultra-filtrated infant formula (U-H), a casein/whey-based infant formula (CW-H). By immunoblotting we demonstrated that all tested formulae still contain antigens with molecular weights from 3 to 67 kD. But when compared with I-F and PM the antigen content of the hydrolysed formulae was considerably lower. The lowest antigen content could be demonstrated in U-H, which contains casein fragments (3-6 kD) and beta-lactoglobulin and its fragments (6-18 kD). W-H and CW-H contain bovine serum albumin, beta-lactoglobulin, casein and their fragments (3-67 kD). All hydrolysed formulae tested showed a reduced IgE-binding capacity. Three out of 12 cow's milk allergic children possessed IgE binding to U-H or W-H, and 5 of them IgE against CW-H. Conclusion. The enzymatic hydrolysis plus ultra-filtration seems to be the most efficient method to reduce the antigen content of so-called hypo-allergenic infant formulae.

[Antigenicity and allergenicity of hypoallergenic hydrolysate for infant nutrition]. / Untersuchung zur Antigenität und Allergenität der hypoallergenen Hydrolysate zur Säuglingsernährung.

The antigenicity/allergenicity of protein components in hypoallergenic formulae is altered by hydrolysis. Two different hydrolysate formulae, hydrolysate 1 = cow milk based; hydrolysate 2 = soya/beef collagen based, were investigated with respect to their specific IgG/IgE binding capacities using the sera of 41 healthy controls, 40 atopic and 12 cow milk allergic subjects. Furthermore, histamine liberation from basophils on incubation with milk proteins and the hydrolysates was measured in 5 healthy and 3 cow milk allergic individuals. Nearly all probands demonstrated specific IgG binding with hypoallergenic formulae. Anti-hydrolysate 1 IgG titres were higher than titres against hydrolysate 2 in the cow milk allergic and healthy populations. Nonhydrolyzed cow milk elicited IgE binding in all cow milk allergic sera. IgE-antibody for hydrolysate 2 could only be demonstrated in one atopic subject. Hydrolysate 1 showed binding capacity for the IgE-antibody of one atopic and 3/12 cow milk allergic patients. Histamine liberation followed in-vitro incubation with both hydrolysates in one out of 3 cow milk allergic subjects and two out of these cases following incubation to unprocessed cow milk protein. A decreased antigenicity/allergenicity can be demonstrated for the two hydrolysates investigated, however antigenic/allergenic reactivity is still present to some degree. Therefore, the therapeutic application of hypoallergenic formulae in patients with specific sensitization to cow milk should be based on the results of the above-mentioned in-vitro parameters and if necessary skin tests and oral challenges.