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A systematic clinical examination of the foot, including a structured medical history, is essential for the diagnostics of foot disorders. The foot and ankle, with a total of 28 bones and numerous joints, require a variety of musculotendinous and neuromuscular structures for stabilization and faultless gait. Almost all anatomical structures of the foot are easily accessible for a manual clinical examination due to the sparse soft tissue covering. This requires differentiated and well-founded anatomical knowledge as well as examination experience to be able to distinguish a normal finding from a pathological abnormality. The examination of the contralateral foot is always necessary. A targeted supplementary imaging examination completes the diagnosis.

The hallux valgus deformity is the most common toe deformity of the forefoot and is often associated with a splayfoot. Malpositioning of the small toes may be isolated but are more common in other foot deformities. The understanding of the complex pathoanatomy of the foot is necessary for orthopedic treatment. Conservative treatment is reserved for the early stages. The indications for surgery should be based on clinical and radiographic findings. Countless surgical procedures are available and minimally invasive surgical techniques are also increasingly being used.

Surgical management of rheumatic feet has dramatically changed over the last decades influenced by the development of new pharmacological drugs and tissue-preserving surgical procedures. It has switched from joint resection to joint-sparing procedures as the method of choice. Nevertheless, the surgical interventions commonly used for non-rheumatic patients cannot be applied to rheumatic patients without reflection: in addition to the basic treatment, comorbidities, degree of mobilization of the patient, orthopedic shoe engineering and orthotic treatment play a major role. Due to the decreasing incidence of the classical rheumatic foot, it has become even more important for physicians, physiotherapists and ergotherapists to recognize the development of such a disease as early as possible and immediately start the appropriate treatment.

We report on a tinea faciei caused by Nannizzia (N.) persicolor. The 4‑year-old boy had probably been infected by a guinea pig. Unambiguous infections caused by N. persicolor are rarely seen in Germany; however, this zoophilic and geophilic dermatophyte may only be rarely identified due to its resemblance to Trichophyton (T.) mentagrophytes. Therefore, the diagnostic attributes of N. persicolor and its differentiation from T. mentagrophytes are described. Particularly in case of contact with rodents, N. persicolor should be kept in mind.

The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.

The number of total knee arthroplasties in elderly patients is increasing in accordance with the demographic shift in the population.Analysis of the special situation in the elderly, conservative treatment options, perioperative risk factors, preoperative preparation, special intraoperative features and outcome.Analysis of currently available scientific data and presentation of own scientific study results.Total knee arthroplasty in elderly patients is related to an increased perioperative risk of complications. A thorough interdisciplinary preparation is required to reduce risk factors. Ligament stability of the knee does not correlate with age. The postoperative outcome after total knee arthroplasty in elderly patients is decisively influenced by the preoperative function and psychosocial parameters.Total knee arthroplasty in elderly patients is particularly challenging for orthopedic surgeons and requires close interdisciplinary cooperation.

Intra-articular injections with glucocorticoids are standard procedures according to therapy guidelines in many rheumatic conditions. There is increasing evidence from clinical trials on the treatment of rheumatoid arthritis that more patients will attain the target of remission using a combination of systemic medication and intra-articular injections with glucocorticoids compared to systemic medication alone. Intra-articular injections with glucocorticoids play an important role in the therapeutic management of pediatric rheumatic diseases. In many countries competency in performing intra-articular injections is among the important skills necessary for certification as a specialist in rheumatology.

Cutaneous adverse drug reactions are frequent and present with heterogenous clinical manifestations.Increasingly, case reports describe drug reactions which mimic dermatoses, although exact data on prevalence are missing. Psoriasiform, lichenoid and pityriasiform exanthems are most frequent. The differentiation of these variants from the respective authentic dermatoses is difficult and only a few clinical and histological criteria are helpful. Other dermatoses like lupus erythematosus or bullous autoimmune dermatoses (pemphigus vulgaris, bullous pemphigoid) can be induced by drugs as well. These drug-triggered variations are classified as distinct subclasses of the respective dermatosis.Exact history and evaluation of the clinical course are essential for the diagnosis of drug reactions mimicking dermatoses and present an important challenge for the clinician. A clear-cut differentiation between the genuine dermatosis and its drug-driven simulator is not always possible.

Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP).To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012.In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments.Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), also known as hypersensitivity syndrome (HSS), is a severe and potentially life-threatening drug reaction. The worldwide rate of mortality is about 10 %, its incidence is increasing. Drugs that most frequently induce DRESS are aromatic anticonvulsive drugs (carbamazepine, lamotrigine, phenobarbital), and more recently new retroviral therapies. The pathogenesis of DRESS is not yet fully understood, but is certainly multifactorial involving a combination of immune reactions, ethnic predisposition, genetically determined enzyme deficiencies and reactivation of herpes viruses (HHV-6, HHV-7, EBV, CMV). Because of the involvement of the skin and internal organs, the clinical picture can be very variable. No specific clinical, histologic or laboratory parameter is available, so the diagnosis has to rely on the clinical appearance. The long latency period between start of drug intake and the initial manifestation of DRESS and the successive onset of skin and organ involvement complicates the early diagnosis. Although or even because DRESS represents a diagnostic challenge, detailed knowledge about this disease is of utmost importance to enable early therapeutic actions.

Phototherapy represents one of the essential options in the treatment of skin diseases by dermatologists. The beginnings of phototherapy were based on empirical observations and only later the underlying molecular and cellular mechanisms of the different modalities of phototherapy were unravelled by scientific research. Due to these findings, some phototherapeutic indications were subsequently altered. In this article, the known photobiological effects of ultraviolet radiation will be discussed and put in relation to the different forms of phototherapy as they are applied in the daily practice by dermatologists.

Many people even in the more prosperous countries of Africa have no opportunity to receive the necessary eye operations because of socioeconomical aspects. Personal contacts made it possible for our association called "Kids' and Poors' Eyes International e. V." to take part in an international operation camp in Namibia and enter into a cooperation with the German "Mali-Hilfe" organization. Organized by the Namibian Ministry of Health, three operation camps with international surgeons are held annually in remote places in Namibia. Operation materials, such as intraocular lenses, viscoelastics, suturing and draping materials and operation instruments are brought by the operation teams themselves, the microscopes are supplied by the central eye hospital in the capital city of Windhoek. The operation camps last for 4-5 days plus 2 days for travelling, setting up and dismantling the operation settings. Most patients have in fact become blind by dense cataract and are therefore severely impaired. To treat the mostly mature cataracts, an extracapsular technique with a wide lamellar tunnel cut, use of vision blue, expression of the nucleus and intraocular lens (IOL) implantation has been proven as a routine method and in some cases phacoemulsification is possible. In Mali, one of the poorest countries of the world, we achieved initial promising results with the implementation of an educational system to train resident surgeons. We got in touch with Mali via the help of the German-Mali humanitarian organisation "Malihilfe" and direct contacts to the Mali Minister of the Interior. Our presentation is about the experiences we made in our surgical work in both countries and answers questions about what is expedient and reasonable in high-volume surgical humanitarian aid and in the implementation of a system for self-help.

InGaN/GaN devices are currently used for many applications, for example, full color display, white (RGB) illumination systems and for the realization of shorter wavelength emitters for optical data storage. We previously reported a blinking phenomenon in the photo-luminescence of InGaN device ready single quantum well materials. In this study we observe in high resolution this optical instability with a near-field nano-probe. The phenomenon appears only in local confined domains and does not seem to behave as a bistable state process like reported on quantum dots generated photo-luminescence. We investigated by a modified scanning near-field optical microscope (SNOM) and studied the time/intensity profile of the optical signal with a resolution in the range of 100nm. The dynamics of the blinking was time-resolved and its behaviour studied with Fourier analysis. Despite the intensity oscillations were found to have chaotic component (autocorrelation coefficient is about 0.63), the optical oscillations appear to include regular characteristics. Fourier analysis of the light intensity from confined domains exhibit peaks in the range of 4–5 s. The emergence of these intriguingly slow and partially regular dynamics should shed light on the inner mechanism that are involved in the fundamental processes of optical emission in these devices.

Stool outlet obstruction with incomplete or complete rectal prolapse combined with vaginal vault prolapse is a severe form of pelvic floor insufficiency. Combining laparoscopic resection rectopexy with a vaginal vault mesh colpo suspension is a possible way of correcting this defect.The safety of the combination was evaluated in 18 patients.The procedure was performed successfully with no complications in 16 of the 18 patients. One patient suffered intraoperative rectal injury and therefore received no polypropylene mesh, and one showed intraoperative bleeding requiring transfusion. No secondary surgery was required. Hospital stay lasted an average of 11.4 days (range 8-20) and the urinary catheters could be removed after an average of 4.3 days (range 2-10). No urinary disturbances were noted at the time of hospital release. Short-term mild fever appeared in 28% of cases (5/18). There were two urinary tract infections. No disturbance in healing and no anastomotic insufficiency were observed. The duration of postoperative antibiotic therapy averaged 3 days (range 0-8).The combination of laparoscopic resection rectopexy with a vaginal vault mesh colpo suspension might be safe. The close contact between the mesh and anastomosis might induce no increase in insufficiency. Long-term outcome must still be evaluated.

The combination of systemic interferon-alpha and systemic photochemotherapy is one of the most effective and most frequently administered treatment regimens for mycosis fungoides. Two patients with mycosis fungoides stage IIb with ulcerated tumors were treated with this regimen. While the plaques responded favorably to the combination therapy, the ulcerated tumors were quite resistant despite treatment for several weeks. When topical interferon-beta in a gel base was added to the regimen, a rapid resolution of the tumors was noticed. This observation suggests topical interferon-beta may be an effective adjuvant strategy to be combined with systemic therapy.

Three-dimensional (3D) echocardiography is a new imaging technique that can provide useful information about cardiovascular morphology, pathology, and function. Recent refinements in instrumentation, data acquisition, post-processing, and computation speed allow 3D echocardiography to play an important role in cardiac imaging. These modalities provide comprehensive information on ventricular and valve morphology and function. Combined with 3D color Doppler sonography, further assessment of valvular function and determination of flow in the left ventricular outflow tract and cross-septal defects are now possible. Three-dimensional color flow imaging also makes echocardiography accurate for assessing the severity of mitral regurgitation. The purpose of this review is to describe technical developments in 3D echocardiography and its clinical application in cardiac surgery. Moreover, based on clinical studies at our centre, we describe the morphology of the mitral valve, its flow pattern, and function of the mitral annulus.

Background and aims: We have previously reported that LPS or intestinal manipulation (IM) causes ileus by initiating a molecular and cellular inflammatory response within the intestinal muscularis. Intraperitoneally administered LPS directly activates the resident macrophages of the muscularis through Toll-Like Receptor (TLR)-4. The mechanism, by which IM leads to the activation of resident macrophages, is unkown. Beside direct mechanical stretch activation, IM could provoke a direct translocation of bacterial products from the gut lumen to the muscularis or to the mesenterial lymph nodes. C3H/HeJ mice carry a TLR-4 receptor mutation, that makes them hyporesponsive to LPS compared to C3H/HeN wild-type mice. The aim of our study was to examine the inflammatory response after intraperitoneally administered LPS or IM within the muscularis and within the mesenterial lymphnodes. Methods: Gastrointestinal motility was measured in vivo by transit and in vitro by organ bath techniques. Cytokine mRNA expression was quantified within the muscularis and within mesenterial lymphnodes by real time PCR in both mouse strains. Leukocyte recruitment into the muscularis was detected by myeloperoxidase histochemistry and activation of resident macrophages was detected by immunohistochemistry. Results: After LPS the inflammatory response within the muscularis, the decrease in smooth muscle cell contractility and the inflammatory response within the mesenterial lymphnodes was blunted in C3H/HeJ mice compared to wild-typ mice. In contrast the inflammatory response within the muscularis and the reduction of contractility was not blunted in C3H/HeJ mice after IM. The inflammtory response within the mesenterial lymphnodes was blunted after IM in C3H/HeJ mice. Discussion: IM does not lead to a direct translocation of LPS from the gut lumen into the muscularis but is followed by translocation of LPS to the lymphatic tissue. Inflammatory mediators or bacterial products can thus gain access to the systemic circulation.

As in other western countries the major challenge of liver transplantation in Germany is to expand the number of liver transplantations in respect to the increasing disparity of qualified patients on the waiting list and the still static availability of brain death donor organs. The problem of death on the waiting list has become overt since the German transplantation law has been installed, which has changed the former center-oriented to a patient-oriented allocation weighting waiting time over medical urgency criteria. The more liberal acceptance of so called marginal cadaveric donor livers will probably impair further improvements in the acute and long-term outcome of liver transplantation. This problem can be partially compensated by the use of novel surgical techniques, such as splitting a donor liver to be transplanted into two adult recipients or, more commonly and safe, into an adult and one child. Another alternative to increase the donor pool is living donor liver transplantation, which was first introduced for pediatric recipients but is now increasingly used in adults. In 2001, a constant number of 757 liver transplantations were performed in Germany, including 12.5 % living donor transplantations. Recently, general guidelines for the selection of patients with end-stage liver disease and acute liver failure have been published by the Bundesärztekammer. Additional developments have contributed to improve the results of liver replacement including individualized immunosuppression strategies and novel treatment options to avoid recurrent viral disease following transplantation.

Over the last few years, the results from clinical studies and innovative radiological approaches have significantly altered the management of patients with cerebral venous thrombosis. In contrast to previously held beliefs, cerebral venous thrombosis is considered to be a relatively benign disease with an overall favourable prognosis. Mortality is10%, and the vast majority of patients recover completely. Although the efficacy of heparin has not been unequivocally proven, it is employed in most centres as the standard therapy. There are not sufficient data supporting long-term anticoagulation. In patients with a proven hypercoagulability syndrome, anticoagulation therapy is generally recommended for a period of 6 months. Whether patients with idiopathic thrombosis should also be treated remains controversial. Non-invasive MR and CT angiography techniques have largely replaced conventional angiography for initial evaluation and follow-up examinations. Both methods have a high sensitivity for cerebral venous thrombosis. Local fibrinolytic therapy or other aggressive recanalizing methods can not be generally recommended.

Malignant melanoma is one of those malignancies with worldwide increasing incidence. The prognosis of malignant melanoma is bad because of its early hematogenous and lymphogenous metastases. Earliest possible diagnosis and sensitive follow-up of disease are important parameters to improve prognosis. In the literature a sensitivity of 92% and a specificity of 77% is found for blinded reading of F-18-FDG-PET of the whole body, and a specificity of 100% when clinical information was provided.

Metastases in the thyroid gland are very rare. When they occur, long-term survival is dismal; thus an early diagnosis is critical. Malignant melanoma is one of the tumors which may metastasize to the thyroid gland. Therefore we wanted to demonstrate F18-Fluorodeoxyglucose-Positron emission tomography (F18-FDG-PET) is a sensitive and reliable method to identify such metastases. We report about a 51-year-old man, who had an inguinal lymph node metastasis of a malignant melanoma with unknown primary tumor site. He came to us for an a follow-up F18-FDG-PET investigation. In the PET there was a pathologic FDG-uptake in the left lobe of the thyroid gland. The nodule was removed and showed a malignant melanoma metastasis. This unusual scenario underscores the value of the PET in the oncologic follow-up of patients with malignant melanoma.

The combination of UVB phototherapy with topical application of vitamin D analogs is frequently used for treating psoriasis. This regimen is not only very effective but also has only minimal side effects. Pronounced, persistent hyperpigmentation developed in the psoriatic plaques in a patient who was treated with combined UVB (311 nm) radiation and topical calcipotriol.

In recent studies outpatient treatment of proximal deep venous thrombosis with low-weight-molecular heparin is shown as safe and effective as the treatment within the hospital. The incidence of recurrent thromboembolism, major bleeding and mortality is not higher in an ambulatory setting than in the hospital. The comfort of the patient is higher, the costs can be reduced. The present review discusses the different conditions for ambulatory treatment of deep venous thrombosis. The question will be addressed which patients will probably be considered for outpatient treatment of deep vein thrombosis.

It could be shown from several experiments that carbohydrate-binding mistletoe lectins represent the pharmacologically active constituents of mistletoe extracts. On the basis of these findings, it was possible to develop an extract preparation standardized with respect to the mistletoe lectin concentration. This drug is the first mistletoe preparation that fulfills the criteria of the guidelines for the development of drugs (1) regarding its quality and stability of the active ingredients under certain storage conditions. The quality of this preparation has also been shown in several animal models to demonstrate antitumoral potencies.

Embolia cutis medicamentosa (Nicolau Syndrome) is a very rare complication of intramuscular injections which presents with extensive necrosis of the injected skin area. Intra-arteria and/or para-arterial injections after prior perforation of certain vessels are discussed as possible pathogenetic mechanisms. We describe the occurrence of embolia cutis medicamentosa after intra-articular injections into the knee.

The aim of this study is the analysis of electrical failures in transvenous cardioverter/defibrillator (ICD) lead systems with regard to the importance of device implemented diagnostic and measurement functions and the potential role of an automated device-control in the detection of lead failures.All consecutive ICD patients at our institution were enrolled in this retrospective investigation. The routine follow-up controls consisted in a complete evaluation of all diagnostic and measurement ICD features and additional controls in case of spontaneous arrhythmia episodes.Two hundred thirty patients, 193 male and 37 female, were enrolled in this study (mean age: 61.5 +/- 10.2 years; mean LVEF 32 +/- 9%). During a mean follow-up period of 29.5 +/- 18.4 (6-76) months, lead failure occurred in 19 patients (8%), 16 patients were implanted with an ICD, capable of diagnostic and measurement functions. All nonadequate device discharges could be classified as sensing-failure by stored electrograms. Device implemented measurement features revealed clinical important information in 13/16 patients (81%). In 14/16 patients, the lead defect could not be detected during routine follow-up. At the time of documented lead failure the safety of the implanted devices was already lost in 6/16 patients (38%).Device implemented diagnostic and measurement options are of great importance in the early detection of ICD lead failures. The implementation of automated measurements of lead related parameters in connection with a patient alert function may contribute to a further increase in the safety of ICD therapy.

The aim of this retrospective study was to evaluate the necessity of the replacement of an implantable cardioverter/defibrillator (ICD) in patients with pulse generator battery depletion without an adequate, spontaneous arrhythmia episode during the life-time of the first implanted device. In this study 213 patients with implanted ICDs were enrolled. In 62 patients an elective generator replacement due to battery depletion was performed. Both patient groups (Group A: patients with generator replacement n = 62 and Group B: patients without replacement n = 151) were not different with regard to main clinical characteristics, such as underlying heart disease and left ventricular function. In both groups there was a predominance of male patients (Group A: 89%; Group B: 83%). The mean age was 58 +/- 11 years and 59 +/- 11 years in Group A and Group B, respectively. Coronary artery disease was present in 66% and 68% of the patients. There was a comparable left ventricular ejection fraction: Group A: 30.5 +/- 9% vs Group B: 31.9 +/- 9%. The follow-up time was much longer in Group A patients compared to Group B patients (50.5 +/- 14 vs. 16.5 +/- 11 months). For the total patient group there was a 5 year event-free probability of 23%, no differences were found between both groups. The subanalysis in Group A patients revealed no difference in the probability of ICD-shock occurrence prior to or after the replacement of the pulse generator. In 48/62 (77%) of Group A patients adequate ICD discharges were documented. In 15/62 (24%) patients shock occurred before and after generator replacement. In 6/62 (10%) of Group A patients, the first adequate ICD-therapy was documented after generator replacement. The results of this study indicate the necessity of an ICD-pulse generator replacement even in patients without an adequate device discharge during the life-time of the first implanted device.

PUVA-induced acrobullous dermatosis is characterized by the occurrence of blisters on the acral extremities during PUVA therapy. The tense blisters apparently arise as a result of PUVA damage to the epidermodermal cohesion coupled with friction or trauma. They must be distinguished from phototoxic reactions induced either by UVA over-dosage or excessive psoralen uptake. We report on, two cases of acrobullous PUVA-induced dermatosis, discussing clinical features, pathophysiological aspects and differential diagnosis.

Therapy of pyoderma gangrenosum can be complicated by side effects of the various systemic therapies, including corticosteroids, azathioprin and cyclosporin A. In this paper we report on a 49-year-old patient presenting with recalcitrant pyoderma gangrenosum who was treated successfully by topical application of cyclosporin A. Cyclosporin A serum levels were always in the subtherapeutic range, and no side effects were observed.

From 1989 to 1995, 25 ICU-patients underwent cholecystectomy for acute acalculous cholecystitis (AAC). Preoperative diagnosis remains difficult and ultrasound imaging proved to be the most valid instrument for early diagnosis. Predisposing factors like duration of respiratory failure, extent of surgery, amount of blood loss and mode of analgesia were analyzed. Undelayed surgical treatment was important to avoid further complications such as gangrene or perforation of the gall bladder.

Temporary hair loss is well accepted as a possible result of psoriatic plaques. On the other hand, it is still a controversial issue whether psoriasis can cause scarring alopecia. The following report presents a 38-year-old woman who had been suffering from progressive hair loss from chronic psoriatic plaques of the scalp for some years. Clinical examination revealed an area of scarring alopecia in association with typical features of psoriasis. Histology showed a cord-like fibrosis replacing former hair follicles, a perivascular lymphohistiocytic infiltrate in the upper dermis occasionally invading the follicular epithelium, and characteristic features of psoriasis of the scalp. The clinical course and the lack of evidence for any other causes of scarring alopecia suggest an aetiopathogenetic link between psoriasis and scarring alopecia. Knowledge of this relationship appears to be of practical significance, since efficient antipsoriatic therapy can stop hair loss and thus may be able to prevent scarring.

Due to the invasive nature of myocardial biopsies, a complication rate of up to 2.5%, and the limitations, e.g., at focal distribution of rejection, there is a continuous need for reliable, non-invasive parameters in recognizing moderate (grade 2) and severe (grade 3) acute cardiac allograft rejections in patients treated with cyclosporine A. 64 biopsies of 20 patients with previous heart transplantations in the past 3 weeks to 36 months (mean 11 months) were compared prospectively to Doppler and echocardiographic results. Parameters of systolic function such as percent fractional shortening (FS) and systolic wall thickness of the posterior wall (SWT) remained without significant changes at grade 2 and grade 3 rejections. The same is valid for relaxation parameters such as maximum velocity of posterior wall reduction (PTR), the time interval of endsystole to maximum velocity of posterior wall reduction (tES-PTR), and the isovolumic relaxation time (IVRT). Left-ventricular filling parameters such as maximum early diastolic flow velocity (VEmax) increased significantly from 73.3 +/- 15.2 cm/s in the rejection-free interval (grade 0) to 103.9 +/- 15.0 cm/s at grade 2 rejection and 101.1 +/- 9.2 cm/s at grade 3 rejection (both p0.001). A sensitivity of 50% and a negative predictive value of 77% are, however, too low to diagnose or exclude a moderate or severe acute rejection in the individual case.(ABSTRACT TRUNCATED AT 250 WORDS)

Dyshydrosiform bullous pemphigoid is a clinical variant of bullous pemphigoid in which the lesions appear primarily on palms and soles. Knowledge of this unusual manifestation of bullous pemphigoid may be of practical relevance, since it has to be included in the differential diagnosis of blistering palmoplantar dermatoses. The correct diagnosis is confirmed by histological examination and immunofluorescence, which reveal all the characteristic hallmarks of bullous pemphigoid. Three patients with dyshydrosiform bullous pemphigoid are presented; clinical and histological aspects, findings on immunofluorescence, differential diagnosis and therapy are discussed.

Pemphigus herpetiformis is an unusual variant of pemphigus. Clinically it can resemble Duhring's disease, while histopathological examination and, in particular immunofluorescence yield findings diagnostic for pemphigus. As pemphigus herpetiformis responds quite well to sulfones, recognition of this rare disorder is of practical relevance. In the present report, a case of pemphigus herpetiformis with an unusually young age of onset is presented. In addition, clinical features, results of histopathological examination and immunofluorescence, differential diagnosis and treatment are discussed.

Calcium antagonists (Ca-antagonists) have been used for 2 decades in the treatment of coronary heart disease. Their use has initially been promoted with variant angina, but soon has expanded to all forms of coronary heart disease, entailing both stable and instable angina. Based on promising experimental findings, these drugs have also been given in myocardial infarction, however, with disappointing results. The same was true for secondary prevention. The basic principle underlying Ca-antagonistic therapy of ischaemic heart disease is the improvement of myocardial oxygen balance. On the one hand, Ca-antagonists (in particular verapamil and diltiazem) reduce myocardial oxygen demand via negative inotropic and chronotropic action--on the other hand, the afterload is reduced by peripheral vasodilation. In addition, coronary dilation improves oxygen delivery, especially during exercise. Ca-antagonists inhibit transsarcolemmal Ca-influx, thus preventing deleterious myocardial Ca-overload as seen during ischaemia and atherosclerosis. Indeed, recent human studies have proven a preventive effect of Ca-blockers against atherosclerosis.

Noninfectious pustular reactions can be observed in association with a variety of dermatoses. Thus, precise knowledge of these is important for the differential diagnosis. Toxic pustuloderma (TP) has been described as a clinical entity and is characterenized by the sudden onset of intense erythemas followed by sterile pustulation, primarily located in the flexural areas and groins. Most frequently TP is induced by drugs, in particular by betalactam antibiotics. In this paper, a typical case of TP caused by the combination of amoxicillin and clavulanic acid will be described, and clinical features, pathogenesis and differential diagnosis will be discussed.

The modern industrial and agricultural production provides many contact points for the food animals with several toxic substances. After their ingestion by the way of feed or water they may endanger the human health as residues or environmental contaminants in food of animal origin. Currently meat, milk and eggs produced on farms in the new federal states of Germany are considered to be dangerous with respect to their xenobiotic burden by numerous consumers. The own trials have been made to give first information about lead, cadmium and arsenic concentrations in feedstuffs, meat and milk from different dairy farms in Saxonia. No serious problems could be detected referring to the metal contents in roughage, grain and crops. Only a few feed samples reached eg. exceeded the permissible upper limits for arsenic and cadmium. But none of the examined feedstuffs contained inadmissible lead concentration. Milk and muscle produced in a metal polluted and not polluted areas were very low in cadmium, lead and arsenic. Total different is the situation in the cases of liver and kidney. Both organs of cows held on farms near a smelter were rich in cadmium and lead. The cadmium concentration in liver and kidney often and the lead concentration sometimes exceeded the permissible upper limits for food. In this context cadmium in kidney of older cows seems to be a problem in general. The results of the own examinations give no information about differences in the mean metal burden of feed and food between new and old federal states of Germany.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration of etretinate in a 29-year-old female patient suffering from severe pustular psoriasis caused a dramatic increase in liver enzymes. Liver biopsy revealed changes characteristic for drug-induced hepatitis. After normalization of liver parameters following withdrawal of etretinate, isotretinoin was administered during a severe pustular relapse. In contrast to etretinate, isotretinoin was well tolerated and resulted in a good therapeutic response. Thus, isotretinoin can be considered as an effective and safe therapeutic alternative for pustular psoriasis even after the occurrence of etretinate-induced hepatitis.

Since low molecular weight heparin is used for the prevention of thromboembolism, the coagulation laboratories are in need of a simple, reliable and practicable test for factor Xa inhibition in order to monitor the effect of low molecular heparin in plasma. Effects of subcutaneous administration of 20 mg or 40 mg enoxaparin were studied in blood samples drawn from 20 patients before and 1, 2, 3, 4, 6, 12 and 24 hours after injection. Thrombin time, aPTT, Heptest and the anti-Xa activity (amidolytic assay) were measured. Subcutaneous administration of 20 mg or 40 mg enoxaparin was followed by a barely significant (p less than 0.05) rise in aPTT (only at the higher dosage) and thrombin time four hours after injection. Heptest and amidolytic assay (S-2222) correlated well and significant (p less than 0.01) increases, with maximum values 4 hours after injection, were seen after administration of 20 mg as well as of 40 mg enoxaparin. Higher mean values were achieved after injection of 40 mg than 20 mg enoxaparin. We believe the Heptest to be a quick and easily performed test, giving results which agree well with those of the amidolytic anti-Xa activity reference method.