[The glucagonoma syndrome]. / Das Glukagonom-Syndrom.

We report on our experience with two patients with glucagonoma syndrome and review the recent dermatologic literature. The clinical features are described with special emphasis on necrolytic migratory erythema, the characteristic cutaneous sign of glucagonoma syndrome. Using our histological and ultrastructural findings, we discuss the pathogenesis of necrolytic migratory erythema. Pathognomonic laboratory data and the diagnostic procedures recommended for the evaluation of patients with glucagonoma syndrome are presented. Finally, we discuss the differential diagnosis and describe therapeutic possibilities in the management of this syndrome.

Azathioprine in the treatment of pemphigus vulgaris. A long-term follow-up.

In a prospective long-term study, thirty-seven patients with severe generalized pemphigus vulgaris were treated with a combined corticosteroid-azathioprine regimen. Twenty-nine patients were available for complete follow-up lasting from 4 to 16 years after initiation of therapy. At the time of final evaluation, twenty-seven patients (93%) were alive; two deaths were unrelated to therapy; thirteen (45%) of the patients were free of disease and had not received treatment for up to 132 months; five of these patients had been off therapy for periods ranging from 60 to 132 months; eleven (38%) of the patients were clinically free of disease but still had low titers of antibodies and thus required low-dose maintenance therapy; five (17%) of the patients were well controlled but not completely free of disease. Side effects were rare and mostly related to corticosteroids. Of the original thirty-seven patients, only one death related to disease or therapy occurred and was due to pulmonary tuberculosis. It is concluded that azathioprine-corticosteroid treatment of pemphigus is highly effective and safe; it leads to long-term remissions in most patients and possibly to a cure in some.

Inhibition of tumor growth by an alkylation of the plasma membrane.

The effect of nitrogen mustard (2-chloro-N-2-chloroethyl-N-methylethanamine), Trenimon (2,3,5-trisethyleneiminobenzoquinone-1,4), chlorambucil (4-[p-(bis[2-chloroethyl]amino)-phenyl]butyric acid) and phosphamide mustard (N,N-bis(2-chloroethyl)-diamidophosphoric acid) on Na+/K+-ATPase, membrane fluidity and cell multiplication was studied. With the exception of chlorambucil which does not affect Na+/K+-ATPase all concentrations of the other alkylating agents which inhibit cell multiplication of Ehrlich ascites tumor cells depress the activity of the Na+/K+-ATPase. All alkylating agents--including chlorambucil--caused an increase in the apparent degree of fluorescence polarization after labelling of the plasma membrane with 1,6-diphenyl-1,3,5-hexatriene (DPH). This effect is interpreted as a decrease in membrane fluidity caused by the alkylating drugs. The decrease in membrane fluidity is due to a direct interaction of the alkylating agent with the plasma membrane and is expressed at all concentrations of the drug which inhibit cell proliferation. No effect on membrane fluidity is observed after treatment of cells resistant to nitrogen mustard. The biological consequence of a decrease in membrane fluidity was investigated by growing Friend erythroleukemia cells in the presence of 10 mM cholesterol hemisuccinate. This procedure raises the microviscosity of the plasma membrane and depresses cell proliferation.

[Acne vulgaris--principles and results of treatment with retinoic acid and tetracyclines (author's transl)]. / Akne vulgaris--Grundlagen und Ergebnisse der Behandlung mit Vitamin-A-Säure und Tetrazyklinen

According to the results obtained in a recent clinical trial over a four-year period retinoic acid represents the most effective single agent available for the topical management of acne vulgaris. Retinoic acid yields impressive therapeutic results not only in patients with manifest acne, but, provided it is applied early enough, it is also effective in preventing the severe inflammatory manifestations of this disease. In medium to severe cases of inflammatory acne, topical retinoic acid therapy should be combined with a low-dose, long-term systemic tetracycline regimen. The course of treatment may extend over months or years, depending on the severity of the condition. Particularly patients in the acne-prone age group are candidates for long-term therapy. Retinoic acid therapy, alone or in combination with tetracyclines, proved far superior to conventional regimens with respect to the effective treatment and prophylaxis of acne.

[Spectinomycin (Trobicin) in Male Gonorrhoea (author's transl)]. / Spectinomycin (Trobicin) in der Behandlung der Männlichen Gonorrhoe

28 male patient with uncomplicated acute gonorrhoea were treated with a single intramuscular injection of 2.0 g spectinomycin. All of them were cured. The suitable alternative to penicillin in the treatment of uncomplicated gonorrhoea, but it will not cure simultaneously-acquired syphilis. Its use should, therefore, be restricted to specific indications.

Trends in electron microscopy of skin.

Some trends in electron microscopy of skin have emerged and should be pursued in the future. The fine structure and some basic cellular reaction patterns of epidermal cells are discussed to illustrate the interplay of morphologic, cytochemical, and tracer studies. Intracytoplasmic membranes and secretory granules, lysosomes and endocytic mechanisms, cytomembranes and cell surface specialization are discussed to show how these can be used to arrive at a more meaningful interpretation of structure. Despite all advances, however, a great deal more needs to be done before the details of skin structure are completely elucidated.

[Treatment of acne vulgaris using vitamin A acid]. / Vitamin-A-Säure-Behandlung der Acne vulgaris

Vitamin A acid represents the most effective therapeutic agent available for the topical treatment of acne vulgaris. This is also borne out by the results obtained in 152 patients over a two-year period. Clinical improvement is striking, long lasting remissions can be maintained by continuous treatment, and there appears to be an acceleration of the natural course to spontaneous remission of disease activity. Patients beyond their teens are more likely to remain symptom-free after adequate treatment than younger patients who may require prolonged maintenance treatment. Special attention is given to the appropriate care for Vitamin A acid treated skin and the general management of these patients is outlined. It is stressed that the patient be instructed, in detail, about the course of treatment and the necessity of staying under observation by an experienced dermatologist.