[Perianal dermatitis and its benign simulants]. / Das Analekzem und seine benignen Simulatoren.

Perianal dermatitis is one of the most common proctological disorders. Concerning the etiology, three different types of dermatitis must be distinguished-the most common irritative contact dermatitis, atopic dermatitis and allergic contact dermatitis. The correct diagnosis is essential for adequate and successful treatment. A variety of benign and malignant disorders must be considered in the differential diagnosis of anal dermatitis. Dermatitic clinical disorders which do not respond to therapy should always be biopsied.

[Severe allergic contact dermatitis with generalized spread due to bufexamac presenting as the "baboon" syndrome]. / Schwere allergische Kontaktdermatitis mit generalisierter Streuung auf Bufexamac unter dem Bild eines "Baboon"-Syndroms.

HISTORY AND CLINICAL FINDINGS: A 48-year-old woman presented with acute, pruritic, sharply demarcated, erythematous, maculopapulous exanthem in the anogenital area with disseminated maculae over the back. Several days before, the patient had applied as topical treatment a bufexamac-containing ointment to the anal region. INVESTIGATIONS: The patch test showed an allergic test reaction to bufexamac. DIAGNOSIS: The case presents a serious allergic contact dermatitis with generalization, imitating a baboon syndrome, unequivocally linked to the previous topical treatment. CONCLUSION: During the last 10 years allergic reactions to bufexamac have increasingly been reported, sometimes with erythema multiforme-like reactions. Because of the high rate of sensitization, the serious clinical course of bufexamac allergy and the insidious symptoms of this side effect, sometimes mimicking the disease to be treated, the substance should be used neither for proctological nor for dermatological diseases, even more as these patients are considered to be at high risk of developing allergic contact dermatitis because of the abnormal skin barrier. Considering the data presented, the use of bufexamac should be critically reassessed.

[Secondary lymphedema of the hand as a complication of recurrent erysipelas in irritant contact dermatitis]. / Sekundäres Lymphödem der Hand infolge rezidivierender Erysipele bei irritativem Kontaktekzem.

A 54 year old female hairdresser suffered from occupational irritant contact dermatitis of the hands. As a complication of hand dermatitis, secondary lymphoedema developed following recurrent erysipelas. Fissures occurring in the course of the hand dermatitis presumably enabled entry of streptococci. Treatment of this complication of occupational dermatitis was reimbursed by the Employers Liability Insurance.

Microvascular consequences of thrombosis in small venules: an in vivo microscopic study using a novel model in the ear of the hairless mouse.

Little is known of the development of chronic microvascular alterations following small vessel thrombosis, which is probably due to the lack of appropriate experimental models. Herein we report the first results on thrombosis-associated long-term changes of microvascular permeability and vessel tortuosity and diameter and blood perfusion using the ear of the hairless mouse, and intravital fluorescence microscopy. Thrombosis was induced photochemically in small venules (diameter: 75 to 100 microm) using light/dye exposure (fluorescein isothiocyanate-dextran 150,000), and the microcirculation compromised by the blockade of blood drainage was analyzed before and 30 minutes after induction of thrombosis as well as repeatedly over a 28-day observation period. Thrombus formation resulted in a marked increase (p<0.05) of microvascular permeability (0.85+/-0.11) when compared with baseline values (0.46+/-0.04). Permeability remained elevated (p<0.05) at days 1 (0.67+/-0.07), 3 (0.58+/-0.02), and 7 (0.60+/-0.06), but returned to normal after 28 days (0.43+/-0.03). Tortuosity, diameter, and red blood cell velocity of venular segments, located upstream of thrombus formation, were found unchanged during the entire 28-day observation period. This was probably due to the fact that blood flow from the thrombosis-affected tissue was frequently drained into nonaffected tissue via preexisting "through-fare" channels, serving as venulo-venular collaterals. In accordance, in 10 to 20% of these venular segments the direction of blood perfusion was found changed, while those changes were only rarely observed in venular vessel segments of the nonthrombotic contralateral ears. We conclude that thrombosis in small cutaneous venules is primarily characterized by an increased vascular permeability, reflecting an inflammatory response, similar to what is known from thrombophlebitis in patients. The model presented herein may be a versatile tool to study pathogenesis of chronic microcirculatory derangements in microthrombosis and their prevention by novel therapeutic strategies.

Demonstration of tryptase in bovine cutaneous and tumor mast cells.

We examined three tissue samples from each of four cows with non-lesional skin, tissue samples from a cow with multiple cutaneous mast cell tumors, and samples from another cow in which mast cells were infiltrating multiple lymphosarcomas of the skin, for the presence of tryptase and chymase by enzyme cytochemical and immunohistological methods. The enzyme activities of tryptase and chymase were tested using N-carbobenzoxy-glycilglycil-L-arginine-2-naphthylamide (Z-Gly-Gly-Arg-NA) and naphthol-AS-D-chloroacetate (N-AS-D-CA) as substrates, respectively. Tryptase reactivity could be demonstrated in frozen and Carnoy-fixed paraffin sections. Chymase reactivity was seen in neither frozen nor paraffin sections of formalin- or Carnoy-fixed skin tissues. Antibody linkage with a polyclonal rabbit anti-human skin tryptase antibody was highly specific in bovine normal cutaneous, infiltrating, and tumor mast cells. More than 90% of the tumor mast cells were distinctly tryptase-positive. With alcian blue, only slightly more than 10% of the mast cells stained clearly positive and with methylene blue hardly any staining of mast cell granules could be demonstrated. No antibody labeling of mast cell granules in any of the tissue sections was detected by the use of rabbit anti-dog chymase antiserum. These results indicate that there is a striking antigenic similarity of bovine tryptase to its canine and human equivalents. The demonstration of tryptase is an important tool in confirming the diagnosis of undifferentiated mast cell tumors. In contrast to other species, chymase appears to be completely absent in bovine skin mast cells.

Imprint cytology of the gallbladder mucosa. Its use in diagnosing macroscopically inapparent carcinoma.

The diagnosis of early gallbladder carcinoma is almost impossible before surgery; in many cases the tumors are grossly inapparent. The usefulness of imprint cytology in detecting early carcinoma of the gallbladder mucosa was assessed. Eight macroscopically inapparent carcinomas were diagnosed, and nine grossly evident carcinomas were confirmed by imprint cytology in 120 cholecystectomies. The sensitivity of cytologic diagnosis of macroscopically inapparent carcinoma was 80%, specificity and predictive value were 100%, and efficiency was 97.7%. If overt carcinomas are included, both the sensitivity and efficiency increase, to 89.6% and 98%, respectively. For the diagnosis of dysplasia the sensitivity and predictive value was 84%, specificity 97.6% and efficiency 95.8%. Because of the simplicity and rapidity of imprint cytology of gallbladder mucosa, coupled with its high sensitivity and reliability, it is recommended for the detection of inapparent carcinoma during cholecystectomy in patients at high risk of cancer.

Papillary hyperplasia and cholesterolosis of the gallbladder.

Papillary hyperplasia of the gallbladder was found in 376 patients (28.4%) and cholesterolosis in 206 (15.6%) of 1323 cholecystectomies. An association between these pathological alterations was found (p < 0.001). Papillary hyperplasia was interpreted as a morphological adaptation of the mucosa to permit a greater absorption of cholesterol from the gallbladder lumen to the blood capillaries. By means of this peculiar hyperplasia the surface of interchange increases and, therefore, absorption would be facilitated. It is suggested that papillary hyperplasia could be induced by the increase of bile pressure in the extrahepatic bile ducts and/or by the concentration of bile cholesterol.

Papillary hyperplasia and cholesterolosis of the gallbladder.

Papillary hyperplasia of the gallbladder was found in 376 patients (28.4

) and cholesterolosis in 206 (15.6

) of 1323 cholecystectomies. An association between these pathological alterations was found (p < 0.001). Papillary hyperplasia was interpreted as a morphological adaptation of the mucosa to permit a greater absorption of cholesterol from the gallbladder lumen to the blood capillaries. By means of this peculiar hyperplasia the surface of interchange increases and, therefore, absorption would be facilitated. It is suggested that papillary hyperplasia could be induced by the increase of bile pressure in the extrahepatic bile ducts and/or by the concentration of bile cholesterol.