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The chemokine CCL2 is a potential biomarker for progression of inflammatory skin disease. In a new article of the Journal of Investigative Dermatology, Shibuya et al. (2021) use murine experimental models to show that CCL2‒CCR2‒dependent IL-1β secretion by local skin cells and skin-infiltrating neutrophils are key drivers of skin irritation.

When topical drugs (skin ointments or creams) are used to treat skin diseases on a long-term basis, allergic contact dermatitis (skin inflammation) may develop in response to certain compounds in the cream. Hydrocortisone, however, is an often-prescribed agent that is identical to a hormone produced by the adrenal glands (cortisol, a corticosteroid). To evaluate whether patients with allergic reactions to hydrocortisone are also allergic to that drug (and related agents) given systemically, six patients were studied. The patients had developed allergic contact dermatitis from topical corticosteroids (four used hydrocortisone, two used hydrocortisone-17-butyrate). They were then tested (provoked) with oral hydrocortisone (a systemic drug). One patient received, in addition, a drug similar to ACTH (adrenocorticotropic hormone, which stimulates the production of cortisol by the adrenal glands). A placebo (inactive) drug was administered the day before the ACTH-like drug was given. Results showed that the four patients who were sensitive to topical hydrocortisone developed skin reactions in response to the systemic provocation, while the two who were not allergic to hydrocortisone developed no such reactions. The patients whose adrenal glands were stimulated also developed a skin reaction; the placebo drug was not associated with a reaction. The results show that patients with sensitivity to topical hydrocortisone can develop skin reactions to the drug when it is given systemically, and when their production of cortisol is stimulated. These findings may have clinical importance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pemphigus is a group of conditions marked by the eruption of large vesicles on the skin. Familial benign chronic pemphigus, also called Hailey-Hailey disease, is inherited as an autosomal dominant trait. The disease has periodic remissions and exacerbations, and may be provoked by heat, ultraviolet exposure, sweating, or infection of the skin. Treatment with antifungal and antibacterial agents, both topical and systemic, has been shown to be useful. To determine if patients with Hailey-Hailey disease have an increased risk of developing allergies to topical treatments, 15 patients from 10 families were given a series of skin tests for allergy to a variety of compounds, including those commonly used in the formulation of topical creams and ointments. A total of nine patients had some sort of allergic reaction. Of those nine, seven had reactions to compounds specifically used in the topical medicines. There were no control subjects included in this study, but the high percentage of patients testing positive suggests that they are at high risk for developing contact allergies. The medical literature describes few such cases, which may be due to the fact that in many cases the treatment was of little value and was discontinued. The authors recommend that patients with familial benign chronic pemphigus be routinely given standard patch tests for contact hypersensitivity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cellular inflammation is a characteristic of many skin diseases: inflammatory skin disorders include psoriasis, atopic eczema, contact dermatitis, seborrheic dermatitis and sunburn. The inflammation in these diseases can successfully be [...]

Several compounds that occur naturally in the normal human body are used for medical purposes. Such compounds include growth factors, cytokines and hormones that are identical to their counterparts in [...]

Contact allergies are complex diseases and an important challenge for public health. The purpose of this review is to discuss new developments in the field, including epidemiology and molecular mechanisms of contact allergy.

Fibrosis after myocardial damage can be determined by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). We studied whether ventricular LGE is visible in the ventricles of pediatric and adolescent TOF (tetralogy of Fallot) patients by measuring LGE and investigating whether fibrosis correlated with right ventricular volume, pulmonary regurgitation, N-terminal pro-brain natriuretic peptide (NT-proBNP) or the aminoterminal propeptide of type III procollagen (PIIINP). We also studied if the patient's age, post-operative follow-up time or surgical history would affect LGE.

Baker's asthma and rhinitis are among the most common occupational diseases. Inhaled cereal flours, such as wheat, especially cause this disease.

Background Evaluations of rhinitis reactions in inhalation challenges (ICs) are sparse compared with research on nasal challenges. This study evaluates the outcome of IC tests in assessing occupational rhinitis (OR). It presents the largest rhinologic IC data in the literature, analyzing the exposure method of various agents causing OR and their relation to asthma.Methods Challenge tests performed on 829 individuals with suspected cases of OR were reviewed. Results from both exposures with occupational agents (n = 1229) and placebo (n = 838) were evaluated.Results A total of 10% of the occupational ICs (n = 123) were positive, suggesting OR, and 13% (n = 161) showed asthmatic reaction in the same challenge. In control challenges 2% showed rhinitis and 6% showed asthma symptoms. The most common agents tested were molds (160 tests), flours, and animal fodders (115 tests) and formaldehyde (122 tests). Obeche wood dust and latex produced positive nasal reactions the most frequently, followed by acid anhydrides.Conclusion Although IC is a resource-intensive methodology, the evaluation of nasal symptoms and signs together with bronchial reactions saves time and expense compared with the organization of multiple individual challenges. We encourage the simultaneous evaluation of both nasal and bronchial reactions in IC tests.

Background:The aim of this study was to extend our knowledge of associations among the constructs of alexithymia, depression, somatization and dissociation. Sampling and Methods:924 nonclinical subjects answered questions about depression (21-item Beck Depression Inventory), somatization (13-item somatization part of Symptom Check List-90), dissociation (28-item Dissociative Experiences Scale) and alexithymia (20-item Toronto Alexithymia Scale). In addition, a 12-item General Health Questionnaire (GHQ-12) was administered to detect psychiatric distress among subjects. Results:The results suggested that there was a significant clinical correlation between somatization, dissociation, depression and alexithymia (rho varied from 0.31 to 0.56). The principal component analysis revealed the presence of four components: depression, somatization, dissociation and alexithymia. The use of factor scores diminished the covariance between measures (rho varied from –0.10 to 0.01 between the factor scores). There was almost no correlation between the dissociation factor (rho = 0.06) and alexithymia factor (rho = 0.09) scores and general distress (GHQ-12). Conclusions:This study suggests that while somatization, dissociation, depression and alexithymia are distinct constructs, they correlate to a considerable extent. The use of factor analysis and factor scores should be considered to diminish covariance between the above constructs. Comparing results between factored and unfactored results may prove illuminating. As a case in point, the results suggest that the part of dissociation that coincides with other constructs (overlaps) is associated with distress, whereas the distinct part of dissociation (no shared covariance) is not associated with distress. The same applies to the alexithymia construct. Longitudinal studies are needed to show whether there is a trait such as a relatively stable dissociation component and also whether a separate state-dependent dissociation component exists that is associated with coincident distress, somatization and depression.

AbstractBackground: The aim of this study was to extend our knowledge of associations among the constructs of alexithymia, depression, somatization and dissociation. Sampling and Methods: 924 nonclinical subjects answered questions about depression (21-item Beck Depression Inventory), somatization (13-item somatization part of Symptom Check List-90), dissociation (28-item Dissociative Experiences Scale) and alexithymia (20-item Toronto Alexithymia Scale). In addition, a 12-item General Health Questionnaire (GHQ-12) was administered to detect psychiatric distress among subjects. Results: The results suggested that there was a significant clinical correlation between somatization, dissociation, depression and alexithymia (rho varied from 0.31 to 0.56). The principal component analysis revealed the presence of four components: depression, somatization, dissociation and alexithymia. The use of factor scores diminished the covariance between measures (rho varied from –0.10 to 0.01 between the factor scores). There was almost no correlation between the dissociation factor (rho = 0.06) and alexithymia factor (rho = 0.09) scores and general distress (GHQ-12). Conclusions: This study suggests that while somatization, dissociation, depression and alexithymia are distinct constructs, they correlate to a considerable extent. The use of factor analysis and factor scores should be considered to diminish covariance between the above constructs. Comparing results between factored and unfactored results may prove illuminating. As a case in point, the results suggest that the part of dissociation that coincides with other constructs (overlaps) is associated with distress, whereas the distinct part of dissociation (no shared covariance) is not associated with distress. The same applies to the alexithymia construct. Longitudinal studies are needed to show whether there is a trait such as a relatively stable dissociation component and also whether a separate state-dependent dissociation component exists that is associated with coincident distress, somatization and depression.Copyright © 2004 S. Karger AG, Basel

Magnetocardiographic and body surface potential mapping data measured in 6 patients with multivessel coronary artery disease were used in equivalent current-density estimation (CDE). Patient-specific boundary-element torso models were acquired from magnetic resonance images. Positron emission tomography data registrated with anatomical magnetic resonance imaging data provided the gold standard. Discrete current-density estimation values were computed on the epicardial surface of the left ventricle from difference (stress-rest) ST-segment maps. The ill-posed inverse problem was regularized with 3 different methods (Tikhonov regularization with an identity or a surface Laplacian operator and a maximum a posteriori estimator). Comparisons with positron emission tomography studies showed that the maximum a posteriori estimator is superior to other regularizations, provided that a suitable a priori information is available. In general, good correspondence was found for segments of high and low amplitude in current-density estimations, and the viable and scar areas in positron emission tomography, respectively.

Klinefelter's Syndrome, a sex chromosomal abnormality and the most common cause of male hypogonadism, is characterized by cognitive and psychosexual dysfunction and abnormalities in physical maturation. It may be relatively common yet often undiagnosed and untreated among psychiatric patients. A case of undiagnosed Klinefelter's Syndrome associated with poor psychosocial functioning, an obsessive impulse to damage women'sgenitals and finally a sexual homicide, is presented. Precipitating factors for maladjustment were strongly cathected surgery of undescended testicles, violent and abusive parents, and a fantasy about the mother's being guilty for the patient's physically poor sexual development. Prevention of psychiatric sequelae of Klinefelter's Syndrome should be based on early diagnostics.

Background:Dental products contain many allergens, and may cause problems both for patients undergoing dental treatment and for dental personnel because of occupational exposure. Individual patch test clinics may not study sufficient numbers of patients to collect reliable data on uncommon allergens. Objective:To collect information on dental allergens based on a multicenter study. Materials and Methods:The Finnish Contact Dermatitis Group tested more than 4,000 patients (for most allergens, 2,300 to 2,600 patients) with dental screening series. Conventional patch testing was performed. The total number and percentage of irritant (scored as irritant [IR] or doubtful [?]) and allergic (scored as +, ++, or +++) patch test reactions, respectively, were calculated, as well as the highest and lowest percentage of allergic patch test reactions recorded by the different patch test clinics. A reaction index (RI) was calculated, giving information on the irritancy of the patch test substances. Results:The most frequent allergic patch test reactions were caused by nickel (14.6%), ammoniated mercury (13%), mercury (10.3%), gold (7.7%), benzoic acid (4.3%), palladium (4.2%) and cobalt (4.1%). 2-hydroxyethyl methacrylate (2.8%) provoked most of the reactions caused by (meth)acrylates. Menthol, peppermint oil, ammonium tetrachloroplatinate, and amalgam alloying metals provoked no (neither allergic nor irritant) patch test reactions. Conclusion:Patch testing with allergens in the dental screening series, including (meth)acrylates and mercury, needs to be performed to detect contact allergy to dental products.

Patients with first-episode schizophrenia (n = 27) and age- and education-matched healthy controls (n = 27) were administered the standard version of the Wisconsin Card Sorting Test (WCST), the Wechsler Adult Intelligence Scale-Revised (WAIS-R), and the Rorschach according to the Comprehensive System (CS). Schizophrenic patients achieved a significantly lower full-scale IQ and made more perseverative responses and achieved fewer categories on the WCST than the healthy control group. No significant associations were observed between effort or motivation and WCST performance. Schizophrenic patients who made more perseverative responses tended to be impoverished in terms of available resources, and functioned in a simplistic way when attending to details of the stimulus field. First-episode schizophrenics are able to generate motives and initiate goal-directed activity, but some of them fail to achieve their goals because the cognitive abilities and available resources required for effective planning, purposeful action, or effective performance are impaired.

Handedness is considered an indirect marker for bilateral language capacity in the brain. The Edinburgh Inventory for Handedness and the Dissociative Experiences Scale (DES) were administered to 297 nonclinical volunteers. Female sex, young age, and non-right handedness accounted for 24% of the total variance on the DES, including both pathological and nonpathological dissociative experiences. This is consistent with the hypothesis that cerebral lateralization indicating handedness is a predisposing factor for dissociative episodes especially in female subjects.

The neural mechanisms associated with hypnosis were investigated in a single highly hypnotizable subject by measuring the mismatch negativity (MMN) component of auditory ERP, reflecting the preattentive discrimination of change in stimulus flow, in normal baseline state and under hypnosis. It has been proposed that the frontal inhibition associated with hypnosis can be measured as a decrease in MMN. ERPs were elicited using the passive oddball paradigm with standard and deviant sine tone stimuli of 500 and 553 Hz, respectively. The measurement was repeated in five separate sessions. In hypnosis the MMN was significantly larger compared to baseline. The results indicate that hypnosis can give rise to altered information processing in the brain even at a relatively early, i.e. preattentive level and that the larger MMN measured under hypnosis does not support frontal inhibition theory.

Visual distortions may be a frightening experience. They are often incorrectly diagnosed and easily dismissed. The causes of visual distortions are poorly understood. The aim of this study was to investigate the link between visual distortions and dissociative experiences in a nonclinical population. A total of 297 nonclinical volunteers completed the Dissociative Experience Scale and answered questions concerning visual distortions. Our study suggests that visual distortions are quite common and that there is a clear link between visual distortions and dissociative phenomena. Literature indicates that this may be caused by disturbances in brain lateralization. Bilateral language capacity may interfere with abilities usually associated with the nondominant hemisphere. Research efforts attempting to shed light on the above matter may benefit our knowledge for dissociative phenomena. An interdisciplinary approach is needed.

Immune mechanisms play a central role in various diseases such as eczema and psoriasis, and in the past treatment tended to involve corticosteroids and cytostatic drugs. Organ transplantation has stimulated the development of newer immunosuppressants, some of which have also been found to be efficacious in the inflammatory dermatoses.

Topical FK506 has recently been shown to have an anti-inflammatory effect in vivo in humans. In this study its effects in contact dermatitis were studied in the guinea pig model. Topical FK506 suppressed both irritant and allergic patch-test reactions. The most prominent suppressive effect was seen when skin sites were pretreated with FK506. Topical FK506 did not impair the induction of contact allergy as assessed by challenges, although it suppressed local lymph node cell accumulation during contact allergy induction. Topical FK506 may hold promise as a treatment for skin disorders that respond to oral FK506 or cyclosporin A.

A structure-activity relationship model for prediction of contact allergenic potential of chemicals had previously been developed. The model had been shown to be able to classify known allergens and non-allergens using data on physicochemical and reactivity parameters of functional groups by discriminant two-value multiple regression analysis. To investigate the model, six selected chemicals which had not been previously investigated for allergenicity were studied with both the model and a murine local lymph-node assay. The same compounds were predicted to be allergens (3-bromo-2-coumaranone, 1-nitrocyclohexene and a-acryloyloxy-ß, ß-dimethyl-ß-butyrolactone) and non-allergens (1-carbethoxy-4-piperidone, 6,7-dimethoxy-2-tetralone and 9-acetylanthracene) by both the model and the local lymph-node assay.

We present a case of a man whose severe and chronic nocturnal hallucinosis and daytime sleepiness, based on an atypical variant of sleep terror (ST), had been unsuccessfully treated under a diagnosis of possible temporal epilepsy and narcolepsy. To the patient sleep served a special function of changing coping style, which he was unable to do during waking. In this case, psychotherapy was an unexpectedly effective treatment of the disorder. Movement activity during sleep was lateralized to the non-dominant side of the body as normally, but during parasomnia there was a dominant lateralization. Implications of the asymmetry are discussed.

The phenotypes of the infiltrating cells in 13 patients with delayed hypersensitivity to topical glucocorticosteriods (GCS) were studied from sequential biopsies of positive epicutaneous test reactions by using the avidin-biotin-complex (ABC) technique. Monoclonal antibodies were used to identify the cells with the following phenotypes: T3, T4/T4a, T6, T8, T9, T11, M1, Ia1 (HLA-DR), interleukin-2 receptor/T26a, and dendritic reticular cell. The cellular kinetics of GCS hypersensitivity reactions were compared with delayed hypersensitivity reactions caused by allergens not related to GCS. In both GCS and non-GCS reactions the epidermal dendritic T6 + cells were more numerous than dendritic Ia1 + cells. There was a decrease in the number of both cell types during these reactions; in GCS reactions the decrease in the number of T6 + cells was seen later than in non-GCS reactions. Ia1 + keratinocytes were seen at sites near dermal infiltrates. Compared with the non-GCS delayed hypersensitivity reaction, there were fewer pan T (T11 +/T3+) in the GCS reaction. The relative numbers of M1 + monocytes and the T4/T8 ratio were substantially lower in the latter; these findings can be explained as a GCS effect which modulates the delayed type hypersensitivity reaction.

This study tested whether Gd‐BOPTA/Dimeg or Gd‐DTPA exerts greater relaxation enhancement for blood and reperfused infarcted myocardium. Relaxivity of Gd‐BOPTA is increased by weak binding to serum albumin. Thirty‐six rats were subjected to reperfused infarction before contrast (doses = 0.05, 0.1, and 0.2 mmol/kg). ΔR1 was repeatedly measured over 30 min. Gd‐BOPTA caused greater ΔR1 for blood and myocardium than did Gd‐DTPA clearance of both agents from normal and infarcted myocardium was similar to blood clearance; plots of ΔR1myocardium/ΔR1blood showed equilibrium phase contrast distribution. Fractional contrast agent distribution volumes were approximately 0.24 for both agents in normal myocardium, 0.98 and 1.6 for Gd‐DTPA and Gd‐BOPTA, respectively, in reperfused infarction. The high value for Gd‐BOPTA was ascribed to greater relaxivity in infarction versus blood. It was concluded that Gd‐BOPTA/Dimeg causes a greater ΔR1 than Gd‐DTPA in regions which contain serum albumin.

Six cases of restless legs syndrome in association to mianserin are presented. Similarities and differences to previously reported cases are described. Some theoretical and methodological topics on restless legs syndrome in relation to drug-induced akathisia are discussed.

BACKGROUND AND DESIGN: Palmoplantar pustulosis (PPP) is an inflammatory skin disease characterized by pustule formation, erythema, induration, and scaling of the affected skin of the palms and soles. Palmoplantar pustulosis is usually resistant to treatment. In a double-blind study (phase 1) of 4 weeks, 40 patients with PPP were randomized to receive oral cyclosporine, 2.5 mg/kg per day, or placebo. An open-label dose-finding phase 2 with cyclosporine doses of 1.25, 2.5, and 3.75 mg/kg per day was performed in the following 3 months. The patients were then followed for at least 2 months after termination of cyclosporine treatment. Response to treatment was judged by the number of fresh pustules. Patients displaying a reduction of 50% or greater in the number of pustules, compared with baseline, were defined as responders. RESULTS: Of the patients who completed phase 1, 17 of 19 patients in the cyclosporine group and four of 15 in the placebo group were classified as responders (P<.001). Cyclosporine, but not placebo, significantly reduced formation of new pustules (P=.001). In the subsequent open phase, a daily cyclosporine dose of 1.25 mg/kg appeared to be an effective treatment of PPP in approximately half of the treated patients. Many patients relapsed after initial success with cyclosporine. However, only one patient studied totally failed to respond to cyclosporine treatment. At the end of phase 3, most of the studied parameters had returned to pretreatment levels. The most common side effect was headache in the 2.5 mg/kg per day dosage group; no significant side effects were observed in the 1.25 mg/kg per day dosage group. CONCLUSIONS: Low-dose cyclosporine treatment (1.25 to 2.5 mg/kg per day) is effective in PPP.(Arch Dermatol. 1993;129:1273-1279)

The authors survey the field of psychiatric sleep research from two points of view: the psychologic and the neurophysiologic. The Freudian theory of dreams is discussed in moredetail than other theories, although here, too, only a brief survey is possible. The phenomenon of regression is discussed as a central and productive hypothesis. One fundamental point of view is the one based on evolutionary theory and developmental psychology. Various links between mind and body are outlined. The article also deals with sleep laboratory research and the possibilities it offers, particularly for psychiatry Some suggestions are finally made as to the opportunities offered for psychiatric work in sleep research, at present and in the future.

Lauerma K, Saeed M, Wendland MF, Derugin N, Yu KK, Higgins CB. The use of contrast-enhanced magnetic resonance imaging to define ischemic injury after reperfusion comparison in normal and hypertrophied hearts. Invest Radiol 1994; 29527-535.

There are no previous reports concerning comorbidity of psychosis and idiopathic familial restless legs syndrome (RLS). In the psychiatric literature the concept "Ekbom's syndrome" has been equated with delusions of parasitosis and not to a paresthetic, organic disorder. Psychotic patients invariably receive the diagnosis of akathisia. We report a family with genetic disposition to idiopathic RLS and psychotic illness. Excellent short-term treatment effect of tramadol for idiopathic RLS is reported for the first time. Four-limb actometry. a novel method for diagnosing and measuring RLS and alcathisia, is described. We suggest that the relationship of RLS, psychosis, and idiopathic or drug-induced akarhisia has been obscured by nosologic difficulties. RLS should be considered a diagnosis and treated even among psychotic patients, although it may be rare. Tramadol may be useful in short-term treatment of RLS.

We describe two cases of neurological motor disorders which were experienced as religious–mystical phenomena by elderly psychotic ladies. One of the patients interpreted a mild hemiparesis as a message from divine forces that changed her left to her right and vice versa. The other patient felt that her perphenazine-induced tardive dyskinesia was the voluntary reading of a silent mantra. Involvement of mystical or religious terms in the interpretation of physical symptoms may lead to the lack of adequate treatment and care. We suggest that a psychosis-related inability to monitor one's own motor behavior is the crucial factor leading to peculiar perception of motor disorders.

The rejection phenomenon has been the major obstacle to advances in organ transplantation, and immunodepression has been only partially effective in controlling rejection. The role of the spleen in the rejection of transplanted tissues is still but poorly understood. We have performed trachea transplantations which are based upon an observation that the rejection phenomenon can be altered through denervation of the spleen. The results of these experiments will be discussed.

The described method of transplantation of larynx and hypopharynx with thyroid and parathyroid glands using continuous hypothermic perfusion has the following advantages.1. The blood supply of the transplanted specimen is practically normal.2. The continuing cold perfusion keeps the transplanted larynx in good condition and allows the surgeons plenty of time to perform the operation.3. Transplantation of thyroid and parathyroid glands in the same specimen together with the larynx ensures that the necessary hormones will be available to the dogs during the postoperative period.4. Transplantation of hypopharynx in the same block together with larynx makes reconstruction of the pharynx easier.5. Infusion of the donor dog's blood into the recipient helps the animal to survive the opsration.6. The separate tracheostoma keeps the pharyngeal secretions out of the trachea and lungs, thus protecting them from infection. The idea of suturing th: caudal opening of the transplanted specimen aside from the midline serves the same purpose.

Eine phoniatrisehe Untersuchung von 38 Patienten, die wegen Stimmbandkarzinom St. I behandelt worden sind.14 chordektomierte Fälle werden mit 24 primär röntgenbestrahllen Fällen hinsichtlich der Stimmfunktion verglichen. Die röntgenbehandelten Patienten batten signifikant viel bessere Stimmqualität und signifikant längere Tonhaltedauer, obzwar diese auch bei den letzteren etwas verkürzt war.Die Chordektomierten wiesen ein kompliziertes Bild von verschiedenerlei Veränderungen im Kehlkopf auf, und der stroboskopische Befund enthüllte bei ihnen fünf verschiedene Arten von Phonationsmechanismus. Die Röntgenbehandelten hatten geringere, aber doch unverkennbare Larynxveränderungen.Auch auf die Notwendigkeit vokaler Rehabilitation wird verwiesen werden.

Lateralized motor and attentional abnormalities contribute to schizophrenia, but little is known about possible abnormalities in neural machinery involved in postural control. We examined postural stability of 22 patients with schizophrenia taking medication and 14 healthy control participants using computerized force platform posturography. The shift in the center point of pressure in the condition of eyes open versus eyes closed characterizes the effect of visual information on body posture. Closing the eyes had less of an effect on the center point of velocity (velocity sm/s) in the patients with schizophrenia than in the control group (median change, 36% vs. 70%, p0.0006). Change in the body position during eye closure tended to be directed rightwards in the control group but leftwards in the group with schizophrenia (p0.025). The results show that visual component had less dominance in the balance control of these patients with schizophrenia. The lateralized effect of visual information on posture was also impaired.

It has been proposed that thickened pericardium is the main cause of the cardiac malfunction in Mulibrey nanism cardiopathy. In contrary, we showed that the pericardial thickness was normal in all our patients. Diastolic 1/3 filling was rapid, but in normal limits when taking into account the young age of our patient population. Although, LV time volume curves did not show remarkable pathologic changes, a restrictive physiology cannot be definitively excluded. LV end diastolic volumes and cardiac output were clearly reduced in our patients. It could be possible that in the course of time the reduced cardiac output affects clinical pattern of heart failure despite of normal systolic function. The reduced LA largest volume and atrial cyclic volume change may partly contribute to the low cardiac output observed in our patients.It has been proposed that thickened pericardium is the main cause of the cardiac malfunction in Mulibrey nanism cardiopathy. In contrary, we showed that the pericardial thickness was normal in all our patients. Diastolic 1/3 filling was rapid, but in normal limits when taking into account the young age of our patient population. Although, LV time volume curves did not show remarkable pathologic changes, a restrictive physiology cannot be definitively excluded. LV end diastolic volumes and cardiac output were clearly reduced in our patients. It could be possible that in the course of time the reduced cardiac output affects clinical pattern of heart failure despite of normal systolic function. The reduced LA largest volume and atrial cyclic volume change may partly contribute to the low cardiac output observed in our patients.

Cryptococcosis is an opportunistic infection caused by a fungus, Cryptococcus neoformans. It is usually seen in immunocompromised patients with AIDS, leukaemia, lymphoma, sarcoidosis or immunosuppressive treatments. We describe a patient who was treated with systemic glucocorticosteroids for 4 years because of lung sarcoidosis. During the last year of treatment, a papular eruption developed which later became ulcerative. In a histopathological examination of a skin biopsy, there was granulomatous inflammation, and the disease was treated as sarcoidosis without success. After 1 year’s unsuccessful treatment, another skin biopsy and skin fungal culture revealed C. neoformans. Cryptococcal antigen was found in blood and cerebrospinal fluid, too. The patient was successfully treated first with an amphotericin-B-flucytosine combination and later with fluconazole.