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Nagel dienen dem Schutz und der Stabilitat der Finger- und Zehenkuppen sowie der taktilen Sensibilitat und fungieren an den Fingern als Greifwerkzeuge. Gleichzeitig stellen kranke Nagel eine kosmetische Einschrankung dar. Nagelerkrankungen verdienen daher ausreichende Beachtung und eine intensive Behandlung.

Zusammenfassung. Dermatophyten verursachen die überwiegende Mehrzahl von Mykosen an Haut und Nägeln, die dann als Tinea bezeichnet werden. Bei typischer Klinik mit randbetontem, schuppenden Erythem, zentralem Abblassen und zentrifugaler Ausbreitung sollte ein Erregernachweis mittels Direktpräparat und Kultur erfolgen. Die unkritische Behandlung unklarer Befunde mit topischen Steroiden sollte ebenso wie der Einsatz von Kombinationspräparaten mit Antimykotikum und Kortikosteroid vermieden werden um nicht durch Maskierung der Klinik eine Tinea incognita zu provozieren. Therapeutisch ist Terbinafin sowohl topisch als auch systemisch das Präparat mit dem besten Kosten/Nutzen-Verhältnis. Auch bei der Onychomykose weist Terbinafin aufgrund der mykoziden Wirkung höhere Abheilungsraten auf. Chronische Lebererkrankungen sind eine Kontraindikation. Interaktionen mit Antidepressiva sind zu beachten. Betablocker sollten nicht zeitgleich eingenommen werden. Gleichzeitige Einnahme von Lipidsenkern stellt im Gegensatz zu den Azolen jedoch kein Problem dar. Bei therapieresistenten Onychomykosen – am häufigsten striäre Varianten – muss unter Umständen eine Nagelteilavulsion oder Keratolyse mit 40 % Urea erfolgen.

Pruritus is associated with various skin diseases, dry skin, and with it an impaired skin barrier function. The study objective was to investigate short-term and long-term effects of two emollients on symptoms and skin barrier functions in xerotic eczema. Randomized, double-blind, study enrolling females/males, with bilateral itching. Two emollients, containing lactic acid and refined almond oil with/without polidocanol were administered on left versus right body sides. Itching severity, skin moisture, lipid content, and pH were assessed on Day 1, within 30-120 min after first administration, and on Days 7 and 14, and compared with baseline assessments. Severity of itching decreased 30 min after first administration of both emollients compared with baseline (p

Clemens von Pirquet (1874 – 1929) pragt den Begriff „Allergie“ nun seit mehr als 100 Jahren. Das Konzept der Allergie war das Resultat von Forschungen im Bereich von Impfung und Serumkrankheit. Pirquet waren bei wiederholter Impfung schneller auftretende und starkere Reaktionen an der Injektionsstelle aufgefallen. Zur Dokumentation der gesteigerten Reaktion impfte sich Pirquet im Selbstversuch uber 5 Tage wiederholt mit Kuhpocken und lies das Resultat am 27. Juli 1905 durch Dr. Carl Henning (1860 – 1917) in einer Moulage festhalten. Diese Moulage von Pirquets volarem Vorderarm zeigt 12 Stunden nach der Impfung eine Quaddel mit Erythem, eine Nekrose nach 48 Stunden, sowie langsame Abheilung bis zum 5. Tag. Die Moulage wurde auch als Photographie in Pirquets Buch „Klinische Studien uber Vakzination und vakzinale Allergie“ von 1907 und weiteren zeitgenossischen Lehrbuchern abgebildet. Eine Kopie der Moulage wurde zu Unterrichtszwecken von Professor Max Tieche (1878 – 1938), dem Grunder der Stadtischen Poliklinik fur Dermatologie (dem heutigen Dermatologischen Ambulatorium des Stadtspitals Triemli) in Zurich verwendet. Heute stellt die Moulage ein eindrucksvolles Zeitzeugnis aus der Geburtsstunde der Allergologie dar.

Summary Background: The diagnosis of parapox virus infections relies primarily on a history of contact with infected animals. The clinical presentation is usually a non-specific necrotic ulcer. The histology may also be non-specific, especially with older lesions. Negative-staining electron microscopy (EM) is a fast and reliable diagnostic tool, but is not widely available. Serological tests and the time-consuming viral culture are also rarely used in Europe. Patients and methods: The diagnostic procedure in two patients with ecthyma contagiosum and milker's nodule using polymerase chain reaction specific for orthopox, parapox and Orf virus is explained. Diagnostics included bacterial culture, viral culture, histology and EM. In addition to these, a polymerase chain reaction (PCR) was performed in both cases. Results: The patient with ecthyma contagiosum was negative for ortho-, parapox-, and orf-virus on PCR, whereas the patient with milker's nodule had a PCR positive for parapoxvirus. Conclusions: PCR is a simple, fast, and standardized method of diagnosis that can distinguish between the subgroups of parapoxviruses. A diagnosis can be made even in cases of ambiguous history or unspecific clinical presentation. The method is limited by the necessity to sample native material or to use neutrally buffered formalin in case of PCR from paraffin material.

Hintergrund: Zur Wirksamkeit der Homöopathie bei atopischem Ekzem (atopische Dermatitis, Neurodermitis constitutionalis atopica) liegen zwar eine Reihe von Kasuistiken, aber keine kontrollierten Therapiestudien vor. Methoden: Monozentrische, randomisierte Doppelblindstudie, in der individuell verordnete homöopathische Arzneien mit Placebo verglichen wurden. Eingeschlossen wurden junge Erwachsene im Alter von 18–35 Jahren mit atopischem Ekzem. Nach einer unbehandelten Eingangsperiode von 4 Wochen wurden alle Patienten 32 Wochen lang behandelt und beobachtet. Als Begleitmedikation waren nur indifferente Salben zugelassen. Hauptzielkriterium war der Multiparameter-Score (MP-Score) von Costa und Saurat. Ergebnisse: Von 744 gescreenten Patienten wurden 24 randomisiert und analysiert (10 Verum, 14 Placebo). Beide Gruppen waren zu Therapiebeginn vergleichbar, die Verumgruppe war allerdings signifikant schwerer erkrankt (p = 0,034, t-Test). 10 Patienten (5 je Gruppe) brachen die Studie vorzeitig ab, vor allem wegen Nicht-Wirksamkeit der Therapie und notwendiger Begleitbehandlungen. In beiden Gruppen fiel der MP-Score deutlich: in der Verumgruppe von 54,5 ±11,0 auf 40,7 ±12,5, in der Placebogruppe von 45,9 ±7,6 auf 32,7 ±21,8, was in einem leichten, nicht signifikanten Gruppenunterschied von 5,6 Punkten zugunsten der Placebogruppe mündete (CI: –9,0 bis 20,2; p = 0,46; ANCOVA). In den sekundären Zielparametern (Lebensqualität, Krankheitsverarbeitung, allgemeine Einschätzung des Therapieerfolgs) ergaben sich ebenfalls keine signifikanten Gruppenunterschiede (jeweils p > 0,15). Schlussfolgerungen: Individualisierte homöopathische Arzneien hatten in dieser Studie zum atopischen Ekzem keinen über Placebo hinausgehenden Effekt. Die Generalisierbarkeit der Ergebnisse ist aufgrund der geringen Fallzahlen und des hohen Prozentsatzes nicht eingeschlossener Patienten eingeschränkt.

We report on a case of a 70-year-old woman with an ocular melanoma, which was diagnosed and treated 14 years ago. The patient was referred to the hospital with a suspected lymphoma. Cytological examination of bone marrow proved a marked infiltration with melanoma cells. Because detection of isolated tumor cells in the bone marrow of patients with various types of tumors was shown to be of prognostic significance and since current tumor-staging techniques are unable to detect single disseminated tumor cells or small aggregates of tumor cells, which might be the seed for subsequent metastatic relapse, we therefore evaluated the feasibility of immunocytochemical screening of bone marrow aspirates of 36 melanoma patients in different clinical stages using three monoclonal antibodies against melanoma-associated antigens in comparison with 43 non-melanoma control patients. Two of these antibodies (HMB45 and NKI-beteb) are directed against the melanoma antigen gp100/pmel17, whereas the third one (TA99) recognizes gp75/Tyrosinase-related protein 1 (TRP-1). None of the patients demonstrated a macroscopic bone marrow infiltration as was present in our patient with metastatic ocular melanoma. Seven (20.6%) of the 34 eligible melanoma patients presented with cells in the bone marrow positive for one or more of the above-mentioned melanosomal markers. Four of the positive patients were clinically free of tumors by the time of puncture, whereas the remaining 3 patients showed overt metastases in the subcutaneous fat (2 patients) and the brain (1 patient). On the other hand, 20 (66%) of the 29 patients with negative bone marrow findings also presented with clinical advanced disease with overt metastasis in the skin, lymph node, spleen, liver, lung, bone and brain. In conclusion, immunocytochemical screening of bone marrow samples is a feasible procedure that allows the detection of micrometastatic tumor cells in a subset of melanoma patients. Massive invasion of bone marrow with melanoma cells is a rare event even in far-advanced metastatic stages and no clear correlation between tumor load and bone marrow infiltration could be established.

Recent trends in Western Europe show an increase in sexually transmitted infections. Surveillance data in Switzerland confirm this rising trend. Notifications of syphilis cases nearly doubled in the year 2002 and almost tripled in 2003. This trend necessitates an early correct diagnosis making reliable screening tests mandatory. In the presented study a particle gel immunoassay (ID-PaGIA syphilis antibody test, Diamed) using recombinant treponemal antigens TpN15, TpN17 and TpN47 was evaluated as a screening test in comparison to the currently used Treponema pallidum particle agglutination test (Serodia-TPPA, Fujirebio). Serum samples were obtained from a cross-sectional sero-epidemiological study among men who have sex with men. Samples were tested with the PaGia and the TPPA. In the case of equivocal results a titrated TPPA of an external laboratory was used as a confirmation test. In total 650 serum samples (48 seropositive patients, 602 negative) were evaluated. The PaGIA showed a sensitivity of 0.89 (43/48) and the TPPA of 0.83 (40/48). This difference was not statistically relevant (p = 0.4). The particle gel assay showed a significantly higher specificity (1.0) compared to the TPPA (0.98) (p = 0.004). The PaGIA showed a sensitivity comparable to that of other treponemal tests with an even better specificity. Advantages of the PaGIA are the fast reaction time of only 20 min and the simplicity of the procedure with minimal technical equipment.

Chronic skin colonization with Staphylococcus aureus is a well-known feature in atopic dermatitis. The aim of this study was to develop a human-SCID mouse model to analyze the possible role of bacterial superantigens in human allergic immune responses under in vivo conditions. SCID mice were reconstituted with peripheral blood mononuclear cells (between 2 and 9 x 10(7) cells per mouse) from atopic dermatitis patients sensitized to house dust mite allergen (Der p). Total and Der p specific antibody production required the following conditions: (i) injection of Der p; (ii) presence of CD14+ antigen-presenting cells; and (iii) IL-4 as shown by the inhibitory effect of human soluble IL-4 receptor on immunoglobulin E production. This model was used to study the immunomodulatory effects of the superantigen staphylococcal enterotoxin B in comparison with Der p. In intraperitoneally reconstituted human-SCID mice, topical treatment was ineffective in inducing skin inflammation. Therefore, additionally to intraperitoneal transfer, peripheral blood mononuclear cells from atopic donors were also injected intradermally. Such reconstituted SCID mice were then exposed via the skin to either Der p, staphylococcal enterotoxin B, or a combination of both. Maximal effects on epidermal inflammation and dermal T cell infiltration were obtained with staphylococcal enterotoxin B and Der p. Staphylococcal enterotoxin B alone was less effective and Der p only stimulated dermal T cell infiltration. These findings support the hypothesis that bacterial superantigens can act as trigger factors in allergic skin inflammation.

Hande und Nagel haben eine wesentliche Bedeutung in der sozialen Interaktion. Gesund aussehende Nagel sind wesentlicher Bestandteil des Korperbilds. Dementsprechend gross ist die Morbiditat bei Nagelveranderungen, sowohl in funktioneller als auch ‒ durch die kosmetische Entstellung ‒ in sozialer Hinsicht

Ziel der vorliegenden Untersuchungen war die Beantwortung der Frage, ob jeweils definiert dosierte, einmalige UVA- und einmalige, erythemauslosende UVB-Bestrahlung quantitativ mesbare Veranderungen relevanter klinischer Parameter menschlicher Haut wie Oberflachenstruktur und viskoelastische Eigenschaften bewirken konnten. Mittels der biophysikalischen Mesmethoden Profilometrie und Cutometrie erfolgten dazu Untersuchungen an nicht sonnenexponierter Haut direkt vor und 24 h nach UVA-Bestrahlung (Dosis: 50 J/cm 2 ) bzw. UVBBestrahlung (Dosis: 1 MED (minimale Erythemdosis)). Insgesamt sprechen unsere Resultate dafur, das einmalige UVA-Bestrahlung in der oben erwahnten Dosisgrosenordnung keine mesbaren Veranderungen der Oberflachenbeschaffenheit (ausgedruckt durch die profilometrisch kalkulierten Parameter Ra und RzDIN fur die Rauhigkeit bzw. Wt fur die Faltentiefe) und viskoelastischen Eigenschaften der Haut (ausgedruckt durch die cutometrisch ermittelten Rationes Uv/Ue fur die Viskositat bzw. Ur/Uf fur die biologische Elastizitat) bewirkt. Einmalige erythemauslosende UVB-Bestrahlung fuhrt ebenfalls nicht zu Rauhigkeitsveranderungen, jedoch zu einer quantifizierbaren Erhohung der Faltentiefe und der Viskositat und einer Verminderung der biologischen Elastizitat der Haut.

Patienten mit phanotypischer Sjogren-Syndrom (SS)-Lupus erythematodes(LE)-Uberlappung stellen eine immungenetisch, serologisch und klinisch einheitliche Krankheitsgruppe dar mit polyzyklisch-anularen, erythematosquamosen Hautlasionen, zirkulierenden SSA(Ro)-Antikorpern und hoher Pravalenz des immungenetischen Phanotyps HLA-DR3. Die Sicca-Symptomatologie des SS kann der LE-Symptomatik zeitlich folgen oder vorangehen. Neben Hautveranderungen wie beim subakuten kutanen LE (SCLE) kommt es zu vaskulitischen, purpuriformen und Sweet-Syndrom-artigen Hautlasionen. Die alteren, vornehmlich weiblichen Patienten zeigen ein erhohtes Risiko pulmonaler und neurologischer Komplikationen. Demgegenuber kommt es selten zu einer Nierenbeteiligung. Eine 81jahrige, anti-SSA(Ro)-, HLA-DR3-positive Frau mit 30jahriger Anamnese eines kutanen LE wird vorgestellt, bei der erst Jahre spater neben den Hautveranderungen eines SCLE eine Sicca-Symptomatik, vaskulitische und Sweet-Syndrom-artige Hautveranderungen auftraten. Wenngleich diskutiert werden kann, ob es sich bei der phanotypischen SS-LE-Uberlappung um ein eigenstandiges Krankheitsbild oder um einen LE mit sekundarem SS bzw. ein primares SS mit Hautmanifestationen handelt, scheint das SS-LE-Uberlappungssyndrom hinreichend gut charakterisiert, um es als eine Krankheitsentitat mit eigenen Implikationen fur die Therapie und Prognose anzuerkennen. Die Stellung des SS/LE-Uberlappungssyndroms im Spektrum der anti-SSA(Ro)-, HLA-DR3-positiven Erkrankungen, und die enge immunologische Verwandtschaft zum SS und zum anti-SSA(Ro)-positiven LE werden diskutiert.

Protein contact dermatitis to meat is well known in butchers; spices are another source of potential contact allergy and usually are not recognized. We present a first case of contact-dermatitis to spice mix in a 39-year-old-butcher. The patient underwent skin prick testing (SPT) with standard allergens (ALK) and different meat and spice extracts (Stallergenes), scratch-patch testing with spice mix containing glutamate, paprika and other spices. Specific serum-IgE was measured with CAP-FEIA. SPT only showed an immediate-type sensitization to mugwort (+ +), as well as different spices (paprika +, curry +, cumin +) and camomile (+ + +). Scratch-patch tests were negative for different meat, but strongly positive for spice mix (+ + +) after 30 min (wheal and flare) and (+ +) after 48 h (infiltration and vesiculation). Two healthy controls were tested negative for spice mix used from that patient (scratch-patch). Specific IgE was slightly elevated for paprika 0.47 kU/L (CAP class 1), anise 0.43 kU/L, curry 0.36 kU/L and mugwort 3.83 kU/L. Sx1 atopy-multiscreen was 3.8 kU/L due to a sensitization to mugwort alone. The tests performed demonstrate an IgE-mediated contact allergy to spices but also a delayed type allergy to spice mix as a manifestation of the mugwort-spice syndrome in this individual. When testing for occupational dermatitis in butchers, protein contact allergy to spices must also be taken into consideration.

Corynebacterium ulcerans is mainly known for its ability to cause animal infections. Some strains of C. ulcerans produce diphtheria toxin, which can cause life-threatening cardiopathies and neuropathies in humans. Human cutaneous C. ulcerans infection is a very rare disease that mimics classical cutaneous diphtheria. We present a very rare case of a C. ulcerans skin infection caused by a non-diphtheria toxin-producing strain of C. ulcerans that resolved after 3 weeks of therapy with amoxicillin-clavulanate. A pet cat was the probable source of infection. The presence of C. ulcerans in the mouth of the cat was confirmed by 16S rRNA gene analysis and the API Coryne system. In cases of human infection with potentially toxigenic corynebacteria, it is important to determine the species and examine the isolate for diphtheria toxin production. If toxigenicity is present, diphtheria antitoxin should be administered immediately. Carriers and potential infectious sources of C. ulcerans include not only domestic livestock but also pet animals. For the primary prevention of disease caused by diphtheria toxin-producing corynebacteria, vaccination with diphtheria toxoid is recommended.

BACKGROUND: The diagnosis of parapox virus infections relies primarily on a history of contact with infected animals. The clinical presentation is usually a non-specific necrotic ulcer. The histology may also be non-specific, especially with older lesions. Negative-staining electron microscopy (EM) is a fast and reliable diagnostic tool, but is not widely available. Serological tests and the time-consuming viral culture are also rarely used in Europe. PATIENTS AND METHODS: The diagnostic procedure in two patients with ecthyma contagiosum and milker's nodule using polymerase chain reaction specific for orthopox, parapox and Orf virus is explained. Diagnostics included bacterial culture, viral culture, histology and EM. In addition to these, a polymerase chain reaction (PCR) was performed in both cases. RESULTS: The patient with ecthyma contagiosum was negative for ortho-, parapox-, and orf-virus on PCR, whereas the patient with milker's nodule had a PCR positive for parapoxvirus. CONCLUSIONS: PCR is a simple, fast, and standardized method of diagnosis that can distinguish between the subgroups of parapoxviruses. A diagnosis can be made even in cases of ambiguous history or unspecific clinical presentation. The method is limited by the necessity to sample native material or to use neutrally buffered formalin in case of PCR from paraffin material.

Atopic dermatitis (atopic eczema) is one of those diseases where homeopaths claim to have good success although this has never been proven by rigorously controlled trials.Single-centre, randomised, double-blind clinical trial comparing homeopathic remedies with placebo in young adults (age 18-35) with atopic dermatitis. Homeopathic remedies were individually administered according to the rules of classical homeopathy. After an untreated baseline period of 4 weeks, all patients were treated and monitored for 32 weeks. Throughout the study, co-medication was allowed only with indifferent emollients. The main outcome parameter was disease severity as assessed by Costa and Saurat's multi-parameter atopic dermatitis score (MP-score).744 patients were screened out of which 24 (10 verum, 14 placebo) were randomised and analysed. Treatment groups were balanced in most baseline parameters but MP-scores were significantly higher in verum patients (p = 0.034, t-test). 10 patients (5 per group) dropped out of the study, mainly because the treatment was perceived as ineffective and co-medication was needed. The MP-score decreased from 54.5 +/- 11.0 to 40.7 +/- 12.5 in the verum group and from 45.9 +/- 7.6 to 32.7 +/- 21.8 in the placebo group, resulting in a non-significant group difference of 5.6 in favour of placebo (CI: -9.0 to 20.2; p = 0.46; ANCOVA). No secondary parameter (quality of life, coping, global assessments of treatment success) showed significant differences between groups (all p0.15).In this study, individualised homeopathic remedies did not prove to be superior to placebo in atopic dermatitis. Yet, generalisability of results is limited due to the small number of patients and the high percentage of ineligible patients.

Junctional epidermolysis bullosa with pyloric atresia (JEB-PA) is an autosomal recessive blistering disease including lethal and non-lethal variants due to mutations in ITGB4 and ITGA6. It is unclear whether PA is caused directly by the mutations in these genes or by other factors. Skin biopsies from patients with JEB were processed for immunofluorescence mapping. When staining for integrin beta4 or alpha6 was absent or reduced, ITGB4 was screened for mutations. A review of known mutations of ITGB4 and the phenotypes of patients with JEB-PA was undertaken. Three novel ITGB4 mutations were identified in 3 families with JEB-PA: 2 splice-site and one insertion mutation. Two families with lethal phenotypes (EB-050 and EB-049) were due to combinations of premature termination codons and missense mutations (658delC/R252C and 3903dupC/G273D, respectively). The third family EB-013 has 2 JEB affected siblings; a brother with PA and a sister without PA. Both were homo notzygous for ITGB4 264G>A/3111-1G>A. Two cases had no gastrointestinal symptoms or signs of PA. PA is an inconstant feature of the subtype of epidermolysis bullosa known as JEB-PA. It is most likely that multiple factors influence the development of PA and its presence is not predictive of a poor outcome. It is possible that institutions that do not routinely screen immunofluore notscence mapping for integrin alpha6beta4 staining in the absence of PA are missing this form of epidermolysis bullosa.

Background: Although allergic mechanisms appear to be important, the pathogenesis of both extrinsic and intrinsic forms of atopic dermatitis (AD) is unknown. Methods: We compared the cytokine production of peripheral blood mononuclear cells of extrinsic AD (EAD) and intrinsic AD (IAD) patients and normal control individuals after stimulation with anti-CD3 and/or anti-CD28 monoclonal antibodies (mAbs) in the presence or absence of anti-CD2-blocking mAb. The cytokine production was measured by immunoassays in supernatants of 24-hour cultures. Results: EAD patients showed a decreased capacity to synthesize interferon gamma and granulocyte-macrophage colony-stimulating factor upon anti-CD3 mAb stimulation as compared with IAD patients. Both EAD and IAD patients demonstrated an increased production of interleukin (IL)-5 and IL-13. As expected, interferon gamma, granulocyte-macrophage colony-stimulating factor, and IL-5 levels were reduced in the presence of anti-CD2-blocking mAbs. CD28 costimulation restored the release in cultures with anti-CD2 mAbs added, suggesting that CD2 and CD28 have redundant functions in T cell activation and subsequent cytokine production. Strikingly, the IL-13 production was not blocked by anti-CD2 mAbs and also not increased by agonistic anti-CD28 mAb, in particular within the EAD patient group. Conclusion: The signalling pathway initiated by the T cell receptor complex leading to increased IL-13 production in AD patients appears to be highly sensitive and is largely independent on CD2 costimulatory signals.

Oranges are suspected of inducing adverse skin reactions in patients with atopic eczema. We studied 21 adult patients with atopic eczema and a history of adverse reactions to oranges and 10 patients without. A dietary history, skin tests, serum IgE and oral provocation tests with oranges were obtained. Severity of eczema was monitored by SCORAD, and serum tryptase, eosinophil cationic protein and urinary methylhistamine were measured. No allergic reactions were found to orange in skin prick or patch tests. However, 23 patients (74%) had specific serum IgE to orange. Oral provocation testing resulted in pruritic eczematous or maculopapular skin lesions predominantly at the predilection sites in 16 patients (52%). The SCORAD increased significantly in patients positive to the oral provocation test (p

Bruchige Nagel sind eine in der dermatologischen Sprechstunde haufig vorgebrachte Beschwerde, finden sie sich doch bei bis zu 20% der Bevolkerung. Frauen sind etwa doppelt so oft betroffen wie Manner. Einfache pflegende Ole oder Cremes, eine systemische Eisensubstitution oder Biotinprodukte konnen je nach Ursache der Nagelprobleme sinnvoll sein.

Die periungualen Fibrome bei der tuberosen Sklerose werden auch als Koenen-Tumoren bezeichnet. Joannes Henricus Maria Koenen, geboren am 10. Marz 1893 in Eindhoven, gestorben in Bois-le-Duc am 29. Mai 1956, studierte von 1910 bis 1918 an der Universitat Amsterdam. Anschliesend war er als Arzt am Coudewater-Irrenhaus in Rosmalen tatig, ab 1929 in der Heilanstalt Voorburg in Vught. Wahrend dieser Tatigkeit schrieb er seine Arbeit uber die tuberose Sklerose, in der die periungualen Fibrome erstmals photographisch dargestellt werden. Seine Promotion erfolgte am 22. Juni 1933 an der Universitat Leiden mit einer Arbeit zum Thema „Schwachsinnigkeit bei Kindern. Ihre Bedeutung in padagogischer und sozialer Hinsicht, auf Grund einer Untersuchung in einigen Gemeinden in Noord-Brabant”. Spater wurde Koenen Inspektor der Staatlichen Irrenaufsicht. Die Erstbeschreibung der periungualen Fibrome erfolgte bereits 1903 durch Richard Kothe in Munchen.

Der Epikutantest ist seit beinahe 100 Jahren ein Standardverfahren zur diagnostischen Abklarung von Kontaktallergien. Das von Jadassohn beschriebene Verfahren wurde erheblich verandert. Die Test- und Ablesebedingungen wurden durch Richtlinien (z. B. Richtlinien der ICDRG) standardisiert, optimale Testkonzentrationen und beste Testmedien fur die einzelnen Testsubstanzen wurden fur eine grose Zahl von Stoffen ermittelt und durch Vereinbarungen in Arbeitsgruppen vereinheitlicht. Der Dermatologische Noxenkatalog und der Handbuchartikel von Borelli enthalten eine Vielzahl von Angaben zu optimalen Testkonzentrationen und Testmedien [1, 2]. Die Applikation der Testsubstanzen auf den Rucken wurde durch Modifikation von Pflastern und Applikationsvorrichtungen deutlich verbessert.

The possible effects of cigarette smoking on sperm quality were investigated in a blind study of 333 healthy male volunteers 19 to 40 years of age. All subjects with clinically proven abnormalities, operations, or inflammatory diseases of the genital organs, exposure to radiation exceeding routine x-ray examination, or medication were excluded, and the data from 150 smokers, 37 ex-smokers, and 52 never-smokers were evaluated. There was a small but insignificant decrease in sperm density from never-smokers to ex-smokers and to smokers. Eight smokers (6%) had sperm counts less than 1 X 10(6)/ml, whereas none of the ex-smokers or never-smokers fell into this category. This difference, however, is not statistically significant (P = 0.084). No statistically significant effect of smoking habits on sperm density, motility, and morphologic features was detected. It is concluded that smoking does not affect the motility and morphologic features of sperm in healthy adult men. The diminished sperm density in heavy smokers may be related to factors associated with smoking.

Zu eigenen Untersuchungen uber die Kaltwellvertraglichkeit wurden nahezu 1000 Personen herangezogen, die fast alle dem Friseurgewerbe angehorten. Entgegen einer Vielzahl von anderslautenden Mitteilungen, in denen die Zahl der Hautschaden als unbedeutend beziffert wurde, ergab sich, das etwa 70% der laufend mit Kaltwellflussigkeiten arbeitenden Personen unter toxisch verursachten Hautschaden litten. — Der untersuchte Personenkreis wird naher beschrieben. — Als toxische Hautveranderungen kommen eine bestimmte Form der Hyperhidrosis manuum („feuchte Kaltwellhande“) und ein „entzundliches Odem“ vor, deren Morphologie und Pathogenese diskutiert wird.