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Introducción: Lipasa endotelial (LE), enzima que modula el metabolismo de HDL, es sobreregulada por citoquinas-inflamatorias. Diabetes mellitus tipo 2 (DM2) se ha asocia a inflamación subclínica, por lo que se plantea que estos pacientes tendrían niveles elevados de LE. El objetivo del estudio es determinar el efecto de glucosa en expresión de LE en células de cultivo y evaluar la relación entre los niveles de LE y el control glicémico en sujetos con DM2. Método: Células endoteliales humanas (HUVEC) fueron estimuladas con distintas concentraciones de glucosa (5.5, 25 y 50 mmol/L) durante 24 h, se evaluó el efecto sobre la expresión de LE. En sujetos DM2 se midieron niveles de LE, glicemia y hemoglobina glicosilada fracción A1c (HbA1c). Se contó con un grupo control (8) para la determinación de los niveles de la enzima. LE se midió por inmunotransferencia, y los resultados fueron expresados como unidades arbitrarias (UA). Resultados: En células HUVEC la expresión de LE fue directamente proporcional a la concentración de glucosa extracelular (p < 0,05). Se evaluaron 24 sujetos diabéticos (15 mujeres y 9 hombres), edad promedio 60 ± 9,7 años, que presentaron niveles de LE mayores que el grupo control (14911UA y 10250, 18UA respectivamente, p < 0,05). No se encontró relación entre glicemia, HbA1c y LE. Conclusión: En células HUVEC existe relación directa entre glucosa extracelular y LE. Los sujetos diabéticos tuvieron niveles mayores de LE que el grupo control, pero esto no se relacionó con control glicémico, lo que apunta a la existencia de otros factores que participen en el aumento de la expresión de LE.Introduction: Endothelial Lipase (EL), enzyme that modulates HDL metabolism, is overregulated by inflammatory-cytokines. Type 2 Diabetes (DM2) has been associated with a subclinical inflammation, so it has been ruled that these patients could have high levels of EL. The objectives of the research are to determine the effect of glucose in the expression of EL in culturing cells and evaluate the relation between the levels of EL and the metabolic control in patients with DM2. Method: During 24 hours, human endothelial cells (HUVEC) were stimulated with different concentrations of glucose (5.5, 25 and 50 mmol/L), the effect was evaluated over the expression of EL. In DM2 patients levels of EL, glucose and HbA1c were measured. We had a control group (8) to determine the levels of enzyme. EL was measured by immune transference, and the results were expressed by arbitrary units(AU). Results: In HUVEC cells, the expression of EL was directly proportional extracellular glucose (p < 0.05). 24 diabetic patients were evaluated (15 females and 9 males) average age from 60 ± 9,7 years old. The studied group showed levels of EL bigger than the control group (14911AU and 10250, 18AU) respectively (p < 0.05). We found no relation between glucose, HbA1c and EL. Conclusion: In HUVEC cells there is a direct relation between extracell glucose and EL. The diabetic patients had higher levels of EL than the control group, but these was not related with glucose or HbA1c, these shows the existence of other factors that participate in the increasement of EL.

Introduction: Complications in arthroplasty are mostly attributed to wear particle related loosening, infections or mechanical failure. There is no investigation in a large patient series giving data about the frequency of allergic reactions to metals or bone cement components in arthroplasty with complications., Methods: In 92 patients with cemented hip or knee arthroplasty (66 patients with complications, 26 without symptoms) patch testing and medical history were evaluated. Contact allergy rates to metals and potential bone cement components were analyzed as well as type of complaints and allergy history., Results: Main complaints were pain (81.8%), reduced range of motion (54.5%) and local swelling (56.1%). Contact allergy to nickel was shown in 16/66 patients (24.2%), 6.1% were allergic to cobalt and 3.0% to chromium. 21/66 patients (31.8%) showed an allergic reaction to bone cement components (gentamicin 23.8%, benzoyl peroxide 10.6%, hydroquinone 4.5%). Sensitization rates in patients without symptoms were 3.8% to nickel as well as to cobalt and chromium, and 15.4% to gentamicin., Conclusion: Contact allergy rates to metals and potential bone cement components are higher in arthroplasty patients with complications than in the general population., (Copyright (c) Georg Thieme Verlag KG Stuttgart--New York.)

Background: While the use of methyldibromo glutaronitrile (MDBGN) in leave-on products is clearly associated with high sensitization or elicitation risk, such a clear-cut relation could be questioned with regard to rinse-off products., Objective: The objective of this study was to find a maximum non-eliciting concentration for rinse-off products in MDBGN patch test-positive patients., Patients and Methods: We performed a use-related test [repeated open application test (ROAT)] in patients sensitized to MDBGN with a liquid soap containing three concentrations of MDBGN (50, 200, and 400 p.p.m. MDBGN, respectively). The soap at 50 p.p.m. was used twice daily for 4 weeks. If no reaction of the skin was observed, the product with the next higher concentration was used for another 4 weeks, etc., Results: In total, 32/37 evaluated cases [86.5%; lower exact one-sided 95% confidence limit (CL): 73.7%] did not react to any of the preparations. The remaining reacted as follows: 1/37 reacted to 50 p.p.m., 3/37 to 200 p.p.m., and 1/37 to 400 p.p.m. The cumulative non-response to 50 p.p.m. was 97.3% (lower CL: 87.8%)., Conclusions: The majority of subjects sensitized to MDBGN-tolerated rinse-off products containing a maximum concentration of 400 p.p.m. A concentration in rinse-off products in the range of 50 p.p.m. could be regarded as safe for most individuals already sensitized. These concentrations will presumably prevent induction (sensitization) also.

Background Mastocytosis is characterized by the accumulation and activation of mast cells in different organs, most commonly the skin. Miltefosine, a raft modulator, has recently been shown to inhibit the activation of mast cells and to reduce mast cell-driven skin inflammatory responses. Objectives To study the safety and efficacy of topical miltefosine treatment of skin lesions in patients with mastocytosis. Methods Thirty-nine adult patients with mastocytosis with skin involvement were treated in a double-blind, placebo-controlled, parallel trial with topical miltefosine and clobetasol for 2 weeks. Treatment areas were analysed for changes in skin lesions and symptoms following mechanical irritation using novel volumetric imaging techniques and quantitative histomorphometry. Results Miltefosine and clobetasol failed to reduce significantly weals and flare-type skin responses following mechanical provocation. Miltefosine showed a trend towards reducing the volume of weals. Clobetasol significantly decreased the volume of weals and the number of mast cells in the upper dermis. Treatment with miltefosine, but not with clobetasol, was often associated with eczematous skin irritation, which may, at least in part, be related to the formulation of miltefosine containing the potentially irritating alkanol propanediol as the vehicle. Conclusions Raft modulators such as miltefosine are promising candidates for novel therapeutic strategies in patients with cutaneous mastocytosis. Future studies should be performed with improved formulations using nonirritant vehicles.

Objective: To identify the concentration of the fragrance compound hydroxyisohexyl 3-cyclohexene carboxaldehyde (INCI) (HICC) that is sufficiently low not to cause an allergic reaction in patients with proven sensitization., Methods: Repeated open application testing (ROAT) in 64 subjects with 2 preparations (perfume and cream) in different concentration (0.005-2.5%). Confirmatory patch testing with four preparations in two different concentrations (2.5% and 5%)., Results: The concentrations of HICC being tolerated by 90% of those sensitized to HICC are estimated as <88.2 ppm (cream) and <270 ppm (perfume) equivalent to 1.2 microg/cm(2) (perfume) and 4.9 microg/cm(2) (cream). Patch test preparations differed with regard to sensitivity (88.5-98.1%) and specificity (37.5-87.5%) against the ROAT result as external criterion. ROAT concentrations and the reaction strength in patch testing were inversely correlated (Kendall's tau-b: 0.69), both indicating the existence of different degrees of susceptibility., Conclusion: To protect 90% (50%) of people sensitized, the use concentration should be in the range of 0.009-0.027% (0.18-0.34%), depending on the product type. Taking into account these results, excessive concentrations should be avoided, as this would continue to sensitize people. Close monitoring is indispensable to prove the efficacy of any recommendations aiming to prevent induction.

Introduction: There are case reports about patients with metal implant allergy. However, large-scale observations regarding frequency and elicitors are lacking., Material and Methods: For 5 years we have been collecting data in a metal allergy register. Information about history, clinical picture, and allergy test results in patients with suspected allergy to metal implants, mostly osteosynthesis and arthroplasty materials, is obtained by means of a special consultation and by report forms., Results: Major complaints of the 239 patients were pain (68.2%), swelling (42.1%), and erythema (33.5%). A metal allergy was found in 29.6% of the patients, and 24.8% were allergic to potential bone cement components. In addition, peculiar reactions such as a persistent inflammatory response to metal particles in nickel/cobalt-allergic patients or the disappearance of complaints upon revision surgery using titanium-based materials were seen., Conclusion: After excluding causes such as infection or mechanical failure, allergy diagnosis using a patch test with implant metals and bone cement components is recommended in cases of suspected implant allergy.

Intolerance reactions to endoprostheses may lead to allergological diagnostics, which focus mainly on metal allergy. However, bone cement may also contain potential allergens, e.g. acrylates and additives such as benzoyl peroxide (BPO), N,N-dimethyl-p-toluidine, hydroquinone, and antibiotics (particularly gentamicin). In the Munich implant allergy clinic, we found that 28 of 113 patients (24.8%) with cemented prostheses had contact allergies to bone cement components, mostly to gentamicin (16.8%) and BPO (8.0%). The clinical significance of test results cannot always be shown, but we still recommend including bone cement components in the allergological diagnostics of suspected hypersensitivity reactions to arthroplasty.

Background: Recent clinical data indicate that fast-track surgery (multimodal rehabilitation) leads to shorter postoperative length of hospital stay, faster recovery of gastrointestinal function as well as reduced morbidity and mortality rates. To date, no study has focused on the effects of fast-track surgery on postoperative immune function. This study was initiated to determine whether fast-track rehabilitation results in improved clinical and immunological outcome of patients undergoing colorectal surgery., Methods: Forty patients underwent either conventional or fast-track rehabilitation after colorectal surgery. In addition to clinical parameters (return of gastrointestinal function, food intake, pain score, complication rates and postoperative length of stay), we determined parameters of perioperative immunity by flow cytometry (lymphocyte subgroups) and enzyme-linked immunosorbent assay (interleukin-6)., Results: Our findings indicate a better-preserved cell-mediated immune function (T cells, T-helper cells, natural killer cells) after fast-track rehabilitation, whereas the pro-inflammatory response (C-reactive protein, interleukin-6) was unchanged in both study groups. Furthermore, we detected a significantly faster return of gastrointestinal function (first bowel movement P<0.001, food intake P<0.05), significantly reduced pain scores in the postoperative course (P < 0.05) and a significantly shorter length of postoperative stay (P<0.001) in patients undergoing fast-track rehabilitation., Conclusion: Fast-track rehabilitation after colorectal surgery results in better-preserved cell-mediated immunity when compared with conventional postoperative care. Furthermore, patients undergoing fast-track rehabilitation suffer from less pain and have a faster return of gastrointestinal function in the postoperative course. In addition, postoperative length of hospital stay was significantly shorter in fast-track patients.